Macroprolactin: From laboratory to clinical practice
Endocrinol Diabetes Nutr (Engl Ed). 2021 Apr 23:S2530-0164(21)00082-3.
doi: 10.1016/j.endinu.2020.12.002.
Online ahead of print.
[Article in
English,
Spanish]
Authors
Betina Biagetti
1
, Roser Ferrer Costa
2
, Rocío Alfayate Guerra
3
, Elías Álvarez García
4
, Eugenio Berlanga Escalera
5
, Gregori Casals
6
, Margarita Esteban Salán
7
, María-Luisa Granada Ibern
8
, Jorge Gorrín Ramos
9
, Nieves López Lazareno
9
, Josep Oriola
6
, Pilar María Sánchez Martínez
10
, M Eugenia Torregrosa Quesada
11
, Eulàlia Urgell Rull
12
, Concepción García Lacalle
13
Affiliations
- 1 Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: bbiagetti@hotmail.es.
- 2 Servei de Bioquímica, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: roferrer@vhebron.net.
- 3 Laboratorio de Análisis Clínicos, Hospital General Universitario de Alicante, Alicante, España.
- 4 Servicio de Análisis Clínicos, Hospital do Meixoeiro, CHU de Vigo, Vigo, Pontevedra, España.
- 5 Laboratori Parc Taulí, Hospital Universitari de Sabadell, Sabadell, Barcelona, España.
- 6 Servicio de Bioquímica i Genética Molecular, Hospital Clínic Universitari, IDIBAPS, Barcelona, España.
- 7 Laboratorio de Bioquímica, Hospital Universitario Cruces, Barakaldo, Vizcaya, España.
- 8 Servicio de Bioquímica Clínica, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España.
- 9 Servicio de Boquímica, Laboratorio de Hormonas y Biomarcadores, Hospital General Universitario Gregorio Marañón, Madrid, España.
- 10 Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España.
- 11 Servicio de Análisis Clínicos, Laboratorio de Hormonas, Hospital General Universitario de Alicante, Alicante, España.
- 12 Servei de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
- 13 Servicio de Análisis Clínicos, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. Electronic address: cglacalle@salud.madrid.org.
Abstract
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
Keywords:
Big prolactin; Gran prolactina; Macroprolactin; Macroprolactina; Polietilenglicol; Polyethylene glycol; Prolactin; Prolactina.
Copyright © 2021 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.