Evaluation of hyperprolactinaemia with the use of the intervals for prolactin after macroforms separation

Macroprolactin (MaPRL) - a complex of monomeric prolactin (PRL) with immunoglobulin G, may be a cause of laboratory diagnosed hyperprolactinaemia. To quantify MaPRL, a precipitation with polyethylene glycol may be performed. This method involves calculating of recovery ratio but the cut-off value is not precisely determined. Moreover, it is proposed that the assessment of macroprolactinaemia should include also the evaluation of real PRL concentration which means the level of the hormone after macroforms separation. The study included 245 patients with hyperprolactinaemia, in whom precipitation was performed. A recovery ratio ≤40% indicated macroprolactinaemia. The real PRL concentrations of the studied subjects were compared with reference ranges suggested by the assay manufacturer and with new intervals for PRL after macroforms separation. On the base of the recovery ratio after the precipitation, macroprolactinaemia was detected in 21 persons. In these patients true hyperprolactinaemia (elevation of real PRL concentration above manufacturer's reference ranges) was noted in 9 cases. Among 224 patients with a recovery >40%, real PRL concentration turned out to be within the manufacturer's reference range (pseudohyperprolactinaemia) in 36 persons. The new intervals for PRL after macroforms separation were about 20% lower than the manufacturer's reference ranges. After applying new ranges in patients with macroprolactinaemia, true hyperprolactinaemia was observed in 14 persons, while in the group without MaPRL dominance, pseudohyperprolactinaemia was noted in 5 patients. The use of the recovery ratio only to recognize macroprolactinaemia may lead in some subjects to the misclassification of the results. For that reason the assessment of the PRL concentration after macroforms separation that can help to distinguish true hyperprolactinaemia and pseudohyperprolactinaemia, seems to be reasonable. To evaluate the real PRL concentration, the reference intervals suggested by the manufacturer of immunoassay might be used. However, possibly better means to diagnose patients with hyperprolactinaemia accurately is using an appropriate range for the concentration of PRL after macroforms separation.