Quantitative Adjustment for Macroprolactin is an Integral Part of Laboratory Assessment of Hyperprolactinaemia

Heald, Adrian; Blantern, E.; Anderson, Simon; Radford, Daniela; Qureshi, Zubair A.; Nair, Sirimavo; Waldron, Julian; Davies, M.; McCulloch, A. J.; Kane, John

doi:10.1055/s-0032-1304618

Cited by 6 publications

(9 citation statements)

References 8 publications

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“…A misdiagnosis of hyperprolactinaemia can be due to the presence of macroprolactin or “big‐big” prolactin. This is a heterogenous complex of prolactin and immunoglobulin and is the cause of apparent hyperprolactaemia in about 20% of cases . Macroprolactin is detected and contributes to total prolactin measured by most commercial immunoassays, and its presence should be considered in all cases of mild to moderate hyperprolactinaemia.…”

Section: Diagnosis Of Secondary Hypogonadism (Pituitary/hypothalamic mentioning

confidence: 99%

“…Macroprolactin is detected and contributes to total prolactin measured by most commercial immunoassays, and its presence should be considered in all cases of mild to moderate hyperprolactinaemia. Macroprolactinaemia is diagnosed by re‐assaying prolactin following precipitation with polyethylene glycol and most clinical laboratories have protocols in place to check for this when prolactin levels are above the method dependent cut off (approximately 700–1000 mU/L) . To avoid unnecessary investigations, baseline prolactin levels should be measured before initiating certain long‐term treatments (eg, antipsychotics).…”

Section: Diagnosis Of Secondary Hypogonadism (Pituitary/hypothalamic mentioning

confidence: 99%

“…Amisdiagnosisofhyperprolactinaemiacanbeduetothepresence ofmacroprolactinor"big-big"prolactin.Thisisaheterogenouscomplex of prolactin and immunoglobulin and is the cause of apparent hyperprolactaemia in about 20% of cases. 9 Macroprolactin is detected and contributes to total prolactin measured by most commercial immunoassays, and its presence should be considered in all cases of mild to moderate hyperprolactinaemia. Macroprolactinaemia is diagnosed by re-assaying prolactin following precipitation with polyethylene glycol and most clinical laboratories have protocols in place to check for this when prolactin levels are above the method dependent cut off (approximately 700-1000 mU/L).…”

Section: Message For the Clinicmentioning

confidence: 99%

“…Macroprolactinaemia is diagnosed by re-assaying prolactin following precipitation with polyethylene glycol and most clinical laboratories have protocols in place to check for this when prolactin levels are above the method dependent cut off (approximately 700-1000 mU/L). 9 To avoid unnecessary investigations, baseline prolactin levels should be measured before initiating certain long-term treatments (eg, antipsychotics). Patients with persistent and unexplained hyperprolactinaemia should be referred to an endocrinologist.…”

Section: Message For the Clinicmentioning

confidence: 99%

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Serum testosterone levels in male hypogonadism: Why and when to check-A review

et al. 2017

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SummaryAimAlthough “late onset hypogonadism”, a condition that includes low testosterone and symptoms, is common in men over the age of 40 years, diagnosis is not clear cut amongst non‐specialists. It is the aim of this review to provide an up to date picture of how this state should be diagnosed and managed.MethodsWe aim to describe how primary and secondary hypogonadism should be excluded before the diagnosis of late onset hypogonadism is reached. As laboratory testosterone measurements are essential the current pitfalls such as inappropriate sample collection and the use of population derived reference ranges are expanded. We review current evidence to determine associations between late onset hypogonadism and morbidity/mortality and benefits following testosterone replacement therapy.ResultsA review of the current evidence shows that late onset hypogonadism is associated with a worse metabolic state and increased mortality. Longitudinal studies have suggested that significant reductions in both symptoms and mortality are seen, especially in patients with type 2 diabetes.DiscussionThis review highlights the importance of diagnosing late onset hypogonadism due to its association with morbidity/mortality and benefits following testosterone replacement. Thus, after making recommendations to ensure correct diagnosis we speculate whether the time has come to move away from population derived testosterone levels towards evidence based action limits.

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Section: Diagnosis Of Secondary Hypogonadism (Pituitary/hypothalamic mentioning

confidence: 99%

Section: Diagnosis Of Secondary Hypogonadism (Pituitary/hypothalamic mentioning

confidence: 99%

Section: Message For the Clinicmentioning

confidence: 99%

Section: Message For the Clinicmentioning

confidence: 99%

See 2 more Smart Citations

Serum testosterone levels in male hypogonadism: Why and when to check-A review

et al. 2017

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“…This is a heterogenous complex of prolactin and immunoglobulin, and is the cause of apparent hyperprolactinaemia in around 20% of cases. 18,19 Macroprolactin is measured by all commercial immunoassays, to a greater or lesser extent, and its presence should be considered in all cases of mild to moderate hyperprolactinaemia. Macroprolactinaemia is diagnosed by re-assaying after precipitation with polyethylene glycol.…”

Section: Hyperprolactinaemiamentioning

confidence: 99%