Macroprolactinemia – frequent cause of misdiagnosis and mistreatment- A Case Report
Keywords:
Macroprolactin, true prolactin, Polyethylene Glycol, ChemiluminescenceAbstract
Objectives: Macroprolactinemia has often been neglected in the differential diagnosis of hyperprolactinemia, mainly due to the lack of adequate diagnostic methods and awareness among clinicians. This has led to subjecting the patients to a myriad of unnecessary investigations and therapies. Technical difficulties in identification of this molecule have hindered the accurate determination of its frequency and extent of interference. Differentiation between macroprolactinemia and true hyperprolactinemia is a promising concept that will effectively guide the therapy protocol while treating patients.
A 25 year old female, investigated for irregular cycles and secondary infertility and was started with cabergoline regime inappropriately without determination of true prolactin levels which was discontinued after few months.
Methods: Thyroid and fertility hormone profile (FSH, LH, Prolactin, Testosterone, DHEAS, Estradiol, Free T3, Free T4, and TSH) estimation was done in the institutional clinical chemistry laboratory using enhanced chemiluminescence immunoassay on Vitros-Eci platform (Orthoclinical Diagnostics, USA). Polyethylene glycol precipitation test was used to assess the presence of macroprolactin in patient’s serum.
Results: Biochemical findings were suggestive of mild elevation in TSH (5.45 mIU/mL) and elevated prolactin levels (51.3ng/ml). A high LH: FSH ratio along with mild hyperandrogenemia was suggestive of PCOS. True prolactin was estimated using PEG precipitation method and the result obtained was 4.7ng/mL.
Conclusion: The patient had a normal conception after 3 months of therapeutic dose adjustments of thyroxine, regardless of higher total prolactin levels. The finding suggests that determination of true prolactin levels precludes the need for further examinations and medications if the concentrations after precipitating macroprolactin with PEG are normal.
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References
Olukoga AO, Kane JW. Macroprolactinaemia: validation and application of the polyethylene glycol precipitation test and clinical characterization of the condition. Clin Endocrinol (Oxf). 1999 Jul;51(1):119-26.
Germano L, Mormile A, Filtri, L et al. Evaluation of polyethylene glycol precipitation as screening test for macroprolactinemia using Architect immunoanalyser. Immuno-analyse & Biologie Specialisee - Immuno-anal Biol spec.2005, 20. 402-407.
Leslie H, Courtney CH, Bell PM et al. Laboratory and clinical experience in 55 patients with macroprolactinemia identified by a simple polyethylene glycol precipitation method. J Clin Endocrinol Metab. 2001; 86(6):2743-2746.
Lu CC, Hsieh CJ. The importance of measuring macroprolactin in the differential diagnosis of hyperprolactinemic patients. J Med Sci. 2012; 28(2):94-99.
Shimatsu A, Hattori N. Macroprolactinemia: Diagnostic, Clinical, and Pathogenic Significance,Clinical and Developmental Immunology, vol. 2012, Article ID 167132, 7 pages, 2012.
Vaishya R, Gupta R, Arora S. Macroprolactin; a frequent cause of misdiagnosed Hyperprolactinemia in clinical practice. J Reprod Infertil. 2010;11(3):161-167.
Wilson MF, Smith TP. Determination of prolactin: the macroprolactin problem. Best Pract Res Clin Endocrinol Metab. 2013;27(5):725-742.
Sostaric M, Bokulic A, Marijancevic D et al. optimizing laboratory defined macroprolactin algorithm. Biochem Med. 2019; 29(2):020706.
Smith TP, Fahie-Wilson MN. Reporting of Post- PEG Prolactin concentrations: Time to change. Clin Chem. 2010; 56(3):484-490.
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