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Macroprolactin over time: Is there any point in rechecking it in people with a persistently elevated serum prolactin?

Mark Livingston1,2, Syeda F Hashmi1, Sudarshan Ramachandran3,4,5,6,7

  • 1Department of Clinical Biochemistry, Black Country Pathology Services , Walsall Manor Hospital, Walsall, UK.

Clinical Endocrinology
|March 27, 2024
PubMed
Abstract

Insights

Macroprolactinemia status, identified using polyethylene glycol (PEG) precipitation, rarely changes over time in hyperprolactinemic individuals. Repeat testing of macroprolactin is unlikely to alter clinical decisions once initial status is established.

Area of Science:

  • Endocrinology
  • Clinical Chemistry
  • Laboratory Medicine

Background:

  • Macroprolactinemia, a condition where prolactin binds to antibodies, can interfere with accurate serum prolactin level interpretation.
  • While the existence of macroprolactinemia is recognized, its stability over time in hyperprolactinemic patients is less understood.
  • Understanding macroprolactin status variability is crucial for appropriate clinical management of hyperprolactinemia.

Purpose of the Study:

  • To investigate the variability of macroprolactin status over a 9-year period in individuals with hyperprolactinemia.
  • To determine how frequently macroprolactin status changes based on polyethylene glycol (PEG) precipitation assay results.
  • To assess the clinical significance of any observed changes in macroprolactin status.

Main Methods:

  • Analysis of serial serum prolactin measurements from 1810 individuals collected between January 2012 and April 2021.
  • Utilized Roche Cobas 8000 analyser for prolactin measurements and laboratory information system for data extraction.
  • Macroprolactin screening was performed using PEG precipitation on samples with prolactin levels >700 mIU/L, with a cut-off of <60% recovery indicating macroprolactin presence.

Main Results:

  • A total of 2782 macroprolactin screening tests were conducted on 1810 individuals.
  • Macroprolactin screening was positive in 141 measurements from 94 patients.
  • Only 19 patients showed a change in macroprolactin status (above and below the 60% PEG recovery cut-off) during the study period; in 7, this change was clinically significant.

Conclusions:

  • Macroprolactin status, determined by PEG precipitation, demonstrated stability in the majority of hyperprolactinemic patients over a 9-year period.
  • Changes in macroprolactin status were infrequent and rarely led to significant alterations in monomeric prolactin levels.
  • Repeat macroprolactin testing is generally not indicated for clinical decision-making once the initial status is established.
Keywords:
longitudinal trendmacroprolactinmonitoringprolactin

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