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Technology insight: measuring prolactin in clinical samples.
Thomas P Smith1, Lucille Kavanagh, Marie-Louise Healy
1Trinity College Dublin and Department of Investigative Endocrinology, St Vincent's University Hospital, Elm Park, Dublin, Ireland. thomas.smith@ucd.ie
Nature Clinical Practice. Endocrinology & Metabolism
|February 23, 2007
Summary
Diagnosing hyperprolactinemia requires careful evaluation to exclude secondary causes and understand assay limitations. Differentiating true hyperprolactinemia from macroprolactinemia is crucial to prevent misdiagnosis and ensure proper patient management.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Reproductive Medicine
Background:
- Prolactin measurement is a common hormonal investigation for reproductive disorders.
- Hyperprolactinemia affects up to 17% of patients with reproductive issues.
- Accurate diagnosis is challenged by assay limitations and potential interferences.
Purpose of the Study:
- To outline a logical approach for diagnosing hyperprolactinemia.
- To highlight the challenge of differentiating true hyperprolactinemia from macroprolactinemia.
- To emphasize the clinical impact of macroprolactin misdiagnosis.
Main Methods:
- Review of diagnostic strategies for hyperprolactinemia.
- Discussion of immunoassay methodologies for prolactin measurement.
- Analysis of macroprolactin interference in standard assays.
Main Results:
- Automated immunoassays are susceptible to interference.
- Macroprolactinemia is a common cause of biochemical hyperprolactinemia misdiagnosis.
- Up to 10% of biochemical hyperprolactinemia cases may involve macroprolactin.
Conclusions:
- A systematic approach, including excluding secondary causes and understanding assay limitations, is essential for hyperprolactinemia diagnosis.
- Failure to identify macroprolactin leads to significant misdiagnosis and mismanagement.
- Collaboration between clinicians and laboratories is vital for accurate prolactin testing.
