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Purpose: Measurement of prolactin in clinical laboratories is an important part of the management of patients with pituitary adenoma. Prolactin is known to be sensitive to the high-dose hook effect, in the presence of extremely high concentrations. This interference is mentioned in most recent articles discussing prolactin assay and management of pituitary prolactin adenomas [1][2][3]. The objective of our study was to evaluate if the mention of the high dose hook effect is relevant in actual practice.Methods: A serum from a patient with giant macroprolactinoma was assayed by using all the different reagents available in France in 2020 on native serum and after dilution. Technical inserts from manufacturers were reviewed to study information of analytical principles, numbers of steps, and mention to high dose hook effect if necessary.Results: Fourteen reagents were studied; all were two-site immunometric assays, mostly in 1 step (11/14). One tested reagent was sensitive to high dose hook effect leading to falsely low prolactin concentration when measured on native serum. Conclusion:The high-dose hook effect still exists. The evolution of reagents may lead to new reagents sensitive to this effect in the future. We therefore advise that this hook effect be mentioned in the recommendations.
Purpose: Measurement of prolactin in clinical laboratories is an important part of the management of patients with pituitary adenoma. Prolactin is known to be sensitive to the high-dose hook effect, in the presence of extremely high concentrations. This interference is mentioned in most recent articles discussing prolactin assay and management of pituitary prolactin adenomas [1][2][3]. The objective of our study was to evaluate if the mention of the high dose hook effect is relevant in actual practice.Methods: A serum from a patient with giant macroprolactinoma was assayed by using all the different reagents available in France in 2020 on native serum and after dilution. Technical inserts from manufacturers were reviewed to study information of analytical principles, numbers of steps, and mention to high dose hook effect if necessary.Results: Fourteen reagents were studied; all were two-site immunometric assays, mostly in 1 step (11/14). One tested reagent was sensitive to high dose hook effect leading to falsely low prolactin concentration when measured on native serum. Conclusion:The high-dose hook effect still exists. The evolution of reagents may lead to new reagents sensitive to this effect in the future. We therefore advise that this hook effect be mentioned in the recommendations.
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