Hyperprolactinemia

Glezer, Andréa; Bronstein, Marcello D.

doi:10.1007/978-3-030-90684-9_5

Cited by 5 publications

(5 citation statements)

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“…The fluctuation in estradiol may partly be explained by irregular follicle recruitment and atresia. Moreover, prolactin is regulated facilitatively by estradiol (11). Therefore, these may explain the fluctuations in estradiol and prolactin in this case.…”

Section: Discussionmentioning

confidence: 63%

FSH-producing pituitary neuroendocrine tumor as a cause of ovarian hyperstimulation syndrome

Kitamura,

Nanba,

Doi

et al. 2024

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Functioning gonadotroph tumors are rare neoplasms that can cause ovarian hyperstimulation syndrome (OHSS) in women of reproductive age. Here, we present a case of a follicle-stimulating hormone (FSH)-producing pituitary neuroendocrine tumor (PitNET) with irregular menstrual cycles and OHSS in a Japanese woman. A 34-year-old woman with bilateral multi-cystic ovarian mass was referred to our hospital for ovarian surgery. The imaging feature of magnetic resonance imaging (MRI) of the ovary and elevated estradiol levels with normal FSH and low luteinizing hormone (LH) levels led us to suspect the presence of a functioning gonadotroph PitNET. MRI revealed a 19-mm pituitary tumor, and increased tracer uptake was observed in the pituitary lesion on 111In-pentetreotide scintigraphy. Transsphenoidal tumor resection resulted in the resolution of the ovarian enlargement, normalization of her menstrual cycles, and spontaneous pregnancy. Immunohistochemistry (IHC) of the resected tumor for pituitary transcription factors, including steroidogenesis factor 1 (SF1) and estrogen receptor alpha, demonstrated positive immunoreactivity, whereas IHC for pituitary-specific positive transcription factor 1 was negative, suggesting that the tumor belonged to the SF1 lineage of PitNETs (gonadotroph tumor). The tumor cells showed positive expression of FSHβ, while LHβ was mostly negative. Consistent with the high pituitary tumor uptake observed on 111In-pentetreotide scintigraphy, the pituitary tumor showed positive expression of somatostatin receptor 2A. Detailed clinical and histological evaluations will provide useful information to understand these rare functioning gonadotroph tumors better. Learning points Functioning gonadotroph tumors are very rare neuroendocrine tumors of pituitary origin. Women of reproductive age presenting with bilateral multi-cystic ovarian enlargement, irregular menstrual cycles, and hyperestrogenemia under unsuppressed follicle-stimulating hormone (FSH) levels should be evaluated for FSH-producing tumor. Raising awareness of OHSS due to functioning gonadotroph tumors is crucial to prevent unnecessary ovarian surgery. Comprehensive histological analysis may provide useful information to better understand the characteristics of functioning gonadotroph tumors.

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Section: Discussionmentioning

confidence: 63%

FSH-producing pituitary neuroendocrine tumor as a cause of ovarian hyperstimulation syndrome

Kitamura,

Nanba,

Doi

et al. 2024

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…The general term “macro-protein” covers any polymer of the analyte [ 30 ] or a complex between the analyte and other proteins, notably antibodies [ 7 , 31 , 32 ]. The presence of such macro-forms is most often of no impact on the biological function of the analyte but may result in spurious—most often—high values.…”

Section: “Macro-b12” As An Explanation For An Unexpectedly High Plasm...mentioning

confidence: 99%

Macro-B12 and Unexpectedly High Levels of Plasma B12: A Critical Review

Fedosov,

Nexo

2024

Nutrients

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A low total plasma vitamin B12 supports a clinical suspicion of B12 deficiency, while the interpretation of an unexpectedly normal/high level is marred by controversies. Here, we critically review current knowledge on B12 in blood plasma, including the presence of the so-called “macro-B12”. The latter form is most often defined as the fraction of B12 that can be removed by precipitation with polyethylene glycol (PEG), a nonspecific procedure that also removes protein polymers and antibody-bound analytes. Plasma B12 includes B12 attached to transcobalamin and haptocorrin, and an increased concentration of one or both proteins almost always causes an elevation of B12. The total plasma B12 is measured by automated competitive binding assays, often incorrectly referred to as immunoassays, since the binding protein is intrinsic factor and not an antibody. An unexpectedly high level of B12 may be further explored using immunological measurements of haptocorrin and transcobalamin (optionally combined with e.g., size-exclusion chromatography). Nonspecific methods, such as PEG precipitation, are likely to give misleading results and cannot be recommended. Currently, the need for evaluation of a high B12 of unknown etiology is limited since other tests (such as measurements of methylmalonic acid) may better guide the diagnosis of B12 deficiency.

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“…If there is no difficulty with venipuncture, a single collection is sufficient to determine the presence of HPRL. (5,6) Mild HPRLs not consistent with the clinical presentation may be due to pulsatile PRL secretion. Exceptionally, a new confirmatory collection can be carried out with two samples at 15-20 minutes intervals.…”

Section: What Are Common Laboratory Pitfalls In the Evaluation Of Hyp...mentioning

confidence: 99%

“…(7,8) Two notable conditions regarding the prolactin dosing methodology must be considered, namely, the hook effect and macroprolactinemia. (5,6)…”

Section: What Are Common Laboratory Pitfalls In the Evaluation Of Hyp...mentioning

confidence: 99%

Hyperprolactinemia in women: diagnostic approach

Glezer,

Garmes,

Kasuki

et al. 2024

Revista Brasileira De Ginecologia E Obstetrícia / RBGO Gynecology and Obstetrics

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Keypoints• Hyperprolactinemia (HPRL) is a cause of menstrual irregularity, galactorrhea, hypogonadism and infertility.• Serum prolactin measurement should only be performed in the presence of compatible symptoms and/or in the presence of a pituitary tumor, even with an incidental diagnosis. Dosage is not recommended as a routine examination. • There are several causes of HPRL. In most cases, it is caused by pregnancy, hypothalamic-pituitary disconnection or PRL-secreting pituitary adenomas (prolactinomas), or it can also be secondary to the use of medications. • Recognizing clinical, laboratory and imaging findings is essential for the diagnosis of prolactinoma, and its differential diagnoses. Recommendations• Hyperprolactinemia is a condition with diverse etiologies, and its correct identification is essential for the proper treatment and monitoring. • Mild hyperprolactinemia should be confirmed with a new measurement after excluding venipuncture stress. • Macroprolactin testing is indicated in patients with asymptomatic hyperprolactinemia.• If drug-induced hyperprolactinemia is suspected, a new serum prolactin measurement is recommended three days after discontinuation of the drug, when withdrawal is possible. If there is a contraindication and doubt regarding the etiology, pituitary imaging should be performed. • Sellar imaging by magnetic resonance, ideally, or computed tomography if the former is unavailable, should only be done after excluding other causes of HPRL. When sellar imaging is suggestive of a pituitary tumor, evaluate if the size of the lesion and prolactin levels point to the presumptive diagnosis of prolactinomas. FEBRASGO POSITION STATEMENTHyperprolactinemia in women: diagnostic approach

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Hyperprolactinemia

Cited by 5 publications

References 50 publications

FSH-producing pituitary neuroendocrine tumor as a cause of ovarian hyperstimulation syndrome

FSH-producing pituitary neuroendocrine tumor as a cause of ovarian hyperstimulation syndrome

Macro-B12 and Unexpectedly High Levels of Plasma B12: A Critical Review

Hyperprolactinemia in women: diagnostic approach

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