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Prolactin immunoassay: does the high-dose hook effect still exist?

Véronique Raverot^1,2, Pauline Perrin^3,4, Philippe Chanson⁵

¹Service de Biochimie et biologie moléculaire, Hospices Civils de Lyon, LBMMS, F-69677, Hormonologie, Bron cedex, France. veronique.raverot@chu-lyon.fr.

|July 6, 2022

Summary

This summary is machine-generated.

The high-dose hook effect, a known issue in prolactin measurement, still impacts a small number of current assays. This interference can lead to falsely low prolactin levels, necessitating continued vigilance in assay recommendations.

Keywords:

Hook-effect Immunoassay Macroprolactinoma Prolactin Prolactinoma

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Area of Science:

Clinical Chemistry
Endocrinology
Laboratory Medicine

Background:

Prolactin measurement is crucial for managing pituitary adenomas.
The high-dose hook effect can interfere with prolactin assays at very high concentrations.
This interference is a known challenge in prolactin-secreting pituitary adenoma management.

Purpose of the Study:

To assess the continued relevance of the high-dose hook effect in current prolactin assays.
To evaluate the performance of available prolactin assays in France (2020) regarding this interference.

Main Methods:

Serum from a giant macroprolactinoma patient was tested with 14 available prolactin assays in France.
Assays were performed on native serum and diluted samples.
Technical inserts of assays were reviewed for analytical details and hook effect information.

Main Results:

All 14 assays were two-site immunometric assays, with most being one-step (11/14).
Diluted sample results ranged from 17,900 µg/L to 86,900 µg/L.
One assay exhibited the high-dose hook effect, yielding a falsely low result (150 µg/L) for native serum compared to diluted serum (17,900 µg/L).

Conclusions:

The high-dose hook effect persists in a small fraction of current prolactin assays.
Future assay developments may still be susceptible to this interference.
Continued mention of the hook effect in prolactin assay recommendations is advised.