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Macroprolactinemia. Is treatment necessary?

Irene V Lambrinoudaki¹, Olga D Daskalaki, Stathis A Thomopoulos

¹2nd Department of Obstetrics and Gynecology, University of Athens, School of Medicine, Aretaieion Hospital, Athens, Greece.

Hormones (Athens, Greece)

|September 28, 2006

Summary

This case study identifies macroprolactinemia in an asymptomatic woman presenting with hyperprolactinemia. Macroprolactinemia, a condition involving larger prolactin molecules, was diagnosed via PEG precipitation, suggesting a benign cause for elevated prolactin levels.

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Area of Science:

Endocrinology
Reproductive Medicine
Clinical Diagnostics

Background:

Hyperprolactinemia can present with various symptoms, but asymptomatic cases require careful evaluation.
Oral contraceptives (OC) can sometimes influence prolactin levels and menstrual cycles.
Macroprolactinemia is a common cause of elevated serum prolactin, often considered benign.

Purpose of the Study:

To investigate the cause of hyperprolactinemia in a young, asymptomatic woman.
To evaluate the diagnostic utility of Poly-ethylene-glycol (PEG) precipitation in identifying macroprolactinemia.
To discuss the clinical implications and management of asymptomatic macroprolactinemia.

Main Methods:

Clinical evaluation of a 26-year-old woman with incidental hyperprolactinemia.
Hormonal assays including serum prolactin (PRL) levels.
Poly-ethylene-glycol (PEG) precipitation test to differentiate macroprolactin.
Pituitary magnetic resonance imaging (MRI) and anterior pituitary function tests.

Main Results:

Elevated serum prolactin (PRL) levels were detected, initially masked by oral contraceptive use.
Bromocriptine therapy normalized PRL levels and restored menstrual cycles.
PEG precipitation confirmed the presence of macroprolactinemia, explaining the elevated PRL.
Pituitary imaging and function tests were normal, ruling out pituitary adenoma.

Conclusions:

Macroprolactinemia was identified as the cause of hyperprolactinemia in this asymptomatic patient.
The case highlights the importance of macroprolactin testing in unexplained hyperprolactinemia.
Asymptomatic macroprolactinemia may not require treatment, but ongoing research explores potential subtle symptomatology.