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Macroprolactinemia: diagnostic, clinical, and pathogenic significance

Akira Shimatsu1, Naoki Hattori

  • 1Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan. ashimats@kyotolan.hosp.go.jp

Clinical & Developmental Immunology
|January 11, 2013
PubMed

Insights

Macroprolactinemia, characterized by large prolactin (PRL) complexes, is common in hyperprolactinemia patients. Identifying macroprolactin is crucial for accurate diagnosis, preventing unnecessary treatments.

Area of Science:

  • Endocrinology
  • Immunology
  • Clinical Chemistry

Background:

  • Macroprolactinemia involves large prolactin (PRL) complexes, often with IgG and anti-PRL autoantibodies.
  • It presents as hyperprolactinemia without typical symptoms and affects 10-25% of hyperprolactinemia patients.

Purpose of the Study:

  • To define macroprolactinemia, its characteristics, prevalence, and diagnostic approaches.
  • To differentiate macroprolactinemia from other causes of hyperprolactinemia, avoiding unnecessary interventions.

Main Methods:

  • Polyethylene-glycol (PEG) precipitation for screening.
  • Gel filtration chromatography, protein A/G column, and I125-PRL binding studies for confirmation.
  • Analysis of autoantibody epitope and PRL receptor binding site interaction.

Main Results:

  • Macroprolactin, a PRL-IgG complex, is the primary form in sera, leading to elevated total PRL levels.
  • Macroprolactin exhibits lower biological activity due to autoantibody binding near the PRL receptor site.
  • Delayed clearance of autoantibody-bound PRL causes hyperprolactinemia.

Conclusions:

  • Macroprolactinemia is a prevalent, chronic condition often developing before middle age.
  • Screening for macroprolactinemia is essential for accurate hyperprolactinemia diagnosis.
  • Distinguishing macroprolactinemia avoids unnecessary patient examinations and treatments.

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