Prevalência da macroprolactinemia entre 115 pacientes com hiperprolactinemia

Vilar, Lúcio; Moura, Eliane; Canadas, Viviane; Gusmão, Amaro; Campos, Renata; Leal, Edmundo; Teixeira, Luciano; Santos, Vera; Gomes, Bárbara; Lima, Marise; Paiva, Renata; Albuquerque, José de Lima; Egito, Célia S.; Botelho, Carlos; Azevedo, Monalisa F.; Casulari, Luíz Augusto; Naves, Luciana Ansaneli

doi:10.1590/s0004-27302007000100014

Cited by 15 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The gold standard for the diagnosis of macroprolactinemia is gel-filtration chromatography, but because this method is laborious and expensive, polyethylene glycol (PEG) serum precipitation has been widely used as a screening method (16,17,44,45,61,63). The test, which enables the diagnosis in at least 80% of cases, is based on the observation that immunoglobulins exposure to defined concentrations of PEG lead to their insolubilization (1,4,63).…”

Section: Methods For Detection Of Macroprolactinmentioning

confidence: 99%

“…(1,59). In recent studies, its prevalence has ranged between 10-26% (44,(59)(60)(61), but the precise prevalence of macroprolactinemia in hyperprolactinemic populations remains largely unknown.…”

Section: Macroprolactinemiamentioning

confidence: 99%

“…However, many patients with macroprolactinemia can have nonspecific symptoms, and neuroradiological abnormalities are also frequent (see below) (44,59,65). Furthermore, PRL levels are highly variable and overlap with those found in patients with monomeric hyperprolactinemia (44,59,61,65). So, neither of these conditions can be differentiated on the basis of clinical features, MRI findings or PRL levels alone.…”

Section: Clinical Relevancementioning

confidence: 99%

“…On the other hand, at least 10% of the general adult population undergoing dedicated imaging have a possible pituitary microadenoma (80,81). Thus, the lesion seen on the MRI may be an incidental finding in patients whose hyperprolactinemia has other etiologies: drug-induced systemic disease, or macroprolactin predominance (44,59,61,65,68). Furthermore, primary hypothyroidism may result in pituitary hyperplasia and diffuse pituitary enlargement that could lead to misdiagnosis of prolactinoma or pseudoprolactinoma.…”

Section: Imaging Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

Self Cite

112

View full text Add to dashboard Cite

The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22 Keywords Hyperprolactinemia; diagnostic pitfalls; hook effect; macroprolactinemia; pituitary incidentalomas RESUMO A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve--se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outr...

show abstract

Section: Methods For Detection Of Macroprolactinmentioning

confidence: 99%

Section: Macroprolactinemiamentioning

confidence: 99%

Section: Clinical Relevancementioning

confidence: 99%

Section: Imaging Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

Self Cite

112

View full text Add to dashboard Cite

show abstract

“…It is called macroprolactinemia when more than 60% of circulating serum PRL consists of macroprolactin (8). Although the exact prevalence of macroprolactinemia in the population with hyperprolactinemia is unknown, it has been reported to be 10%-25% in various studies [9,10]. Macroprolactin is formed by decreased clearance of PRL in chronic renal failure or more complex formation of immunoglobulin G and monomeric PRL (11).…”

Section: Prolactin Molecule and Macroprolactinemiamentioning

confidence: 99%