Macroprolactin; A Frequent Cause of Misdiagnosed Hyperprolactinemia in Clinical Practice
نویسندگان
چکیده
INTRODUCTION Macroprolactin is a significant cause of misdiagnosis, unnecessary investigation, and inappropriate treatment in patients with hyperprolactinemia. Its frequency has not been clearly established due to technical difficulties in identifying it. Most laboratories and clinicians are unaware of macroprolactin interferences in prolactin assays. MATERIALS AND METHODS A comprehensive literature search was conducted on the websites of the National Library of Medicine (http://www.ncbl.nlm.nih.gov) and PubMed Central, the US National Library of Medicine's digital archive of life sciences literature (http://www.pubmedcentral.nih.gov/). The data were also looked for in relevant books and journal. RESULTS Macroprolactin is a non-bioactive prolactin isoform usually composed of a prolactin monomer and an IgG molecule having a prolonged clearance rate similar to that of immunoglobulins. This isoform is clinically non-reactive but it interferes with immunological assays used for the detection of prolactin. CONCLUSION There is a need to understand and explore the recent progress in the diagnosis and pathophysiology of macroprolactinemia for improving patient care.
منابع مشابه
In hyperprolactinemia, testing for macroprolactin is essential.
Autonomous secretion of prolactin (PRL) by a pituitary prolactinoma is a relatively common endocrine disorder characterized by increased serum concentrations of PRL and symptoms of menstrual irregularity, infertility, and galactorrhea in women and impotence and lack of libido in men (1 ). These clinical symptoms are common, and measurement of serum PRL is a key investigation used to identify th...
متن کاملMacroprolactin and hyperprolactinaemia.
The recent report on “macroprolactin and hyperprolactinaemia” is very interesting. Jamaluddin et al. noted that 4.4 % of the patients have macroprolactin and concluded that “macroprolactin is a significant cause of misdiagnosis, unnecessary investigation, and inappropriate treatment.” Similar to many other “macro” phenomenon (macroCK, macroamylase, etc.), the macroprolactin can result in aberra...
متن کاملMacroprolactinemia: Diagnostic, Clinical, and Pathogenic Significance
Macroprolactinemia is characterized by a large molecular mass of PRL (macroprolactin) as the main molecular form of PRL in sera, the frequent elevation of serum PRL (hyperprolactinemia), and the lack of symptoms. Macroprolactin is largely a complex of PRL with immunoglobulin G (IgG), especially anti-PRL autoantibodies. The prevalence of macroprolactinemia is 10-25% in patients with hyperprolact...
متن کاملHyperprolactinemia: new assay more specific for the monomeric form does not eliminate screening for macroprolactin with polyethylene glycol precipitation.
Prolactin presents important size heterogeneity in terms of circulating molecular forms. Besides the monomer (23kDa), which predominates in healthy subjects as well as in patients with prolactinoma, high molecular forms are also present in low concentrations (1). These high molecular forms include 50 kDa dimers (big prolactin) and also forms with even larger molecular weights (MW>150 kDa), know...
متن کاملFrequent misdiagnosis and mismanagement of hyperprolactinemic patients before the introduction of macroprolactin screening: application of a new strict laboratory definition of macroprolactinemia.
BACKGROUND Macroprolactin (big big prolactin) has reduced bioactivity and is measured by immunoassays for prolactin when it accumulates in the plasma of some individuals. We applied normative data for serum prolactin after treatment of sera to remove macroprolactin to elucidate the contribution of macroprolactin to misleading diagnoses, inappropriate investigations, and unnecessary treatment. ...
متن کامل