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Macroprolactin screening in 464 patients with hyperprolactinaemia
1KK Women's & Children's Hospital, Department of Pathology and Laboratory Medicine, Singapore. lim.ming.hwee@sgh.com.sg.
Introduction:
Macroprolactinaemia is usually detected by polyethylene glycol (PEG) precipitation in clinical laboratories. Laboratory data on prolactin and macroprolactin screening by PEG precipitation in a tertiary hospital were reviewed in order to revise the local policy for reflex screening and reporting of macroprolactin in patients with hyperprolactinaemia.
Materials And Methods:
Paired prolactin results from 464 patients before and after PEG precipitation, either requested by a clinician or performed as a reflex test, were retrieved and reviewed.
Results:
Recovery of prolactin after PEG treatment was highly variable (3.7 to 97.7%). The distribution of prolactin recovery percentages after PEG precipitation in patients with true hyperprolactinaemia was markedly different from that in patients without true hyperprolactinaemia. The proportion of patients with true hyperprolactinaemia increased gradually with increasing pre-PEG prolactin concentrations; the reverse was true with macroprolactinaemia. Five patients (1.1%) were found to have co-existing macroprolactinaemia and true hyperprolactinaemia.
Conclusion:
Results from this retrospective study indicate that macroprolactinaemia is common and can be present even in patients with very high serum prolactin concentrations. There is no cut-off limit for pre-PEG serum prolactin concentration that can totally exclude macroprolactinaemia. Moreover, co-existence of true hyperprolactinaemia and macroprolactinaemia in the same patient is not a rare phenomenon. Post-PEG prolactin concentration and percentage recovery should be reported together to guide the interpretation and management of hyperprolactinaemia.
Insights
Macroprolactinaemia is common, even with high prolactin levels. Reporting post-PEG prolactin and recovery percentage aids hyperprolactinaemia management.
Area of Science:
- Endocrinology
- Clinical Chemistry
Background:
- Macroprolactinaemia diagnosis typically relies on polyethylene glycol (PEG) precipitation.
- Current laboratory policies for macroprolactin screening require revision.
Purpose of the Study:
- To review laboratory data on prolactin and macroprolactin screening using PEG precipitation.
- To revise local policies for reflex screening and reporting of macroprolactin in hyperprolactinaemia.
Main Methods:
- Retrospective review of paired prolactin results (pre- and post-PEG precipitation) from 464 patients.
- Data included clinician-requested and reflex PEG precipitation tests.
Main Results:
- Prolactin recovery after PEG precipitation was highly variable (3.7–97.7%).
- Distinct patterns of prolactin recovery were observed in patients with and without true hyperprolactinaemia.
- Macroprolactinaemia and true hyperprolactinaemia co-existed in 1.1% of patients.
Conclusions:
- Macroprolactinaemia is prevalent and can occur with very high serum prolactin concentrations.
- No specific pre-PEG prolactin concentration reliably excludes macroprolactinaemia.
- Reporting post-PEG prolactin and recovery percentage is crucial for interpreting and managing hyperprolactinaemia.
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