Biochemical diagnosis in prolactinomas: some caveats
- 30 Downloads
Prolactinomas are the most frequently seen pituitary adenomas in clinical practice. A correct biochemical diagnosis of hyperprolactinemia is a prerequisite for further investigation but may be hampered by analytical difficulties as well as a large number of potentially overlapping conditions associated with increased prolactin levels. Suspicion should rise in patients whose symptoms and biochemical results do not match. Assay problems, macroprolactinemia, and high-dose hook effect are discussed as possible reasons for false positive or false negative prolactin levels. Physiological and pathological causes of hyperprolactinemia and their implications for interpreting prolactin results are reviewed.
KeywordsHyperprolactinemia Macroprolactinemia High-dose hook effect Hypothyroidism Chronic kidney disease Liver disease Pregnancy
Compliance with ethical standards
Conflict of interest
Author SP declares that he has no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- 3.Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A (2006) Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65:265–273Google Scholar
- 6.Overgaard M, Pedersen SM (2017) Serum prolactin revisited: parametric reference intervals and cross platform evaluation of polyethylene glycol precipitation-based methods for discrimination between hyperprolactinemia and macroprolactinemia. Clin Chem Lab Med 55:1744–1753PubMedPubMedCentralGoogle Scholar
- 12.Samson SL, Hamrahian AH, Ezzat S (2015) American Association of Clinical Endocrinologists, American College of Endocrinology Disease state clinical review: clinical relevance of macroprolactin in the absence or presence of true hyperprolactinemia. Endocr Pract 21:1427–1435PubMedPubMedCentralGoogle Scholar
- 14.Olukoga AO, Kane JW (1999) Macroprolactinaemia: validation and application of the polyethylene glycol precipitation test and clinical characterization of the condition. Clin Endocrinol (Oxf) 51:119–126Google Scholar
- 15.Suliman AM, Smith TP, Gibney J, McKenna TJ (2003) Frequent misdiagnosis and mismanagement of hyperprolactinemic patients before the introduction of macroprolactin screening: application of a new strict laboratory definition of macroprolactinemia. Clin Chem 49:1504–1509PubMedPubMedCentralGoogle Scholar
- 16.Beltran L, Fahie-Wilson MN, McKenna TJ, Kavanagh L, Smith TP (2008) Serum total prolactin and monomeric prolactin reference intervals determined by precipitation with polyethylene glycol: evaluation and validation on common immunoassay platforms. Clin Chem 54:1673–1681PubMedPubMedCentralGoogle Scholar
- 18.Petakov MS, Damjanović SS, Nikolić-Durović MM, Dragojlović ZL, Obradović S, Gligorović MS, Simić MZ, Popović VP (1998) Pituitary adenomas secreting large amounts of prolactin may give false low values in immunoradiometric assays. The hook effect. J Endocrinol Invest 21:184–188PubMedPubMedCentralGoogle Scholar
- 32.Hutchinson J, Murphy M, Harries R, Skinner CJ (2000) Galactorrhoea and hyperprolactinaemia associated with protease-inhibitors. The Lancet 356:1003–1004Google Scholar
- 35.Bourgeois AL, Auriche P, Palmaro A, Montastruc JL, Bagheri H (2016) Risk of hormonotherapy in transgender people: literature review and data from the French Database of Pharmacovigilance. Ann Endocrinol (Paris) 77:14–21Google Scholar
- 40.Yavuz D, Topçu G, Ozener C, Akalin S, Sirikçi O (2005) Macroprolactin does not contribute to elevated levels of prolactin in patients on renal replacement therapy. Clin Endocrinol (Oxf) 63:520–524Google Scholar
- 52.Raber W, Gessl A, Nowotny P, Vierhapper H (2003) Hyperprolactinaemia in hypothyroidism: clinical significance and impact of TSH normalization. Clin Endocrinol (Oxf) 58:185–191Google Scholar