The Impact on Clinical Practice of Routine Screening for Macroprolactin

Gibney, James; Smith, Thomas P.; McKenna, T. J.

doi:10.1210/jc.2004-2234

Cited by 131 publications

(63 citation statements)

References 36 publications

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“…Prolactinemia was assessed to evaluate activation of the dopamine pathways. In this study, prolactin was evaluated by electrochemiluminescence immunoassay (ECLIA; Roche Diagnostic) (Fahie-Wilson et al 2000;Gibney et al 2005), as was cortisol (Chiu et al 2003).…”

Section: Stimulation Proceduresmentioning

confidence: 99%

Deep TMS on alcoholics: effects on cortisolemia and dopamine pathway modulation. A pilot study

Ceccanti

Inghilleri

Attilia

et al. 2015

Can. J. Physiol. Pharmacol.

122

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The hypothalamic pituitary adrenal axis and dopamine have a key role in transition from alcohol social use to addiction. The medial prefrontal cortex was shown to modulate dopaminergic activity and cortisol releasing factor (CRF) release in hypothalamic and extra-hypothalamic systems. The recent advancements in non-invasive neurostimulation technologies has enabled stimulation of deeper brain regions using H-coil transcranial magnetic stimulation (TMS) in humans. This randomized double-blind placebo-controlled pilot study aims to evaluate H-coil efficacy in stimulating the medial prefrontal cortex. Cortisolemia and prolactinemia were evaluated as effectiveness markers. Alcohol intake and craving were considered as secondary outcomes. Eighteen alcoholics were recruited and randomized into 2 homogeneous groups: 9 in the real stimulation group and 9 in the sham stimulation group. Repetitive TMS (rTMS) was administered through a magnetic stimulator over 10 sessions at 20 Hz, directed to the medial prefrontal cortex. rTMS significantly reduced blood cortisol levels and decreased prolactinemia, thus suggesting dopamine increase. Craving visual analogic scale (VAS) in treated patients decreased, as well as mean number of alcoholic drinks/day and drinks on days of maximum alcohol intake (DMAI). In the sham group there was no significant effect observed on cortisolemia, prolactinemia, mean number of alcoholic drinks/day, or drinks/DMAI. Thus, deep rTMS could be considered a potential new treatment for alcoholism.

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Section: Stimulation Proceduresmentioning

confidence: 99%

Deep TMS on alcoholics: effects on cortisolemia and dopamine pathway modulation. A pilot study

Ceccanti

Inghilleri

Attilia

et al. 2015

Can. J. Physiol. Pharmacol.

122

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“…Gibney et al demonstrated that screening leads to substantial cost savings by decreasing the number of MRI exams and prescriptions for dopamine agonists [44].…”

Section: Macroprolactinmentioning

confidence: 99%

Hyperprolactinemia

Chahal

Schlechte

2008

Pituitary

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In several respects prolactin is unique among anterior pituitary hormones. The primary regulation of prolactin secretion is mediated through hypothalamic inhibition, and the diagnosis of hyperprolactinemia can be established without the use of stimulation or suppression tests. Documenting the presence of hyperprolactinemia is not difficult-the challenge is in identifying the cause of the hormone hypersecretion. With immunoradiometric assays falsely low levels of prolactin are occasionally seen in patients with macroadenomas and very high serum prolactin (the hook effect). Macroprolactin should be suspected when a patient with hyperprolactinemia does not present with typical clinical symptoms, and all hyperprolactinemic sera should be screened for macroprolactin. With prolactinomas, prolactin levels generally parallel tumor size. Prolactin secreting macroadenomas are typically associated with levels that exceed 250 microg/l and may exceed 1,000 microg/l. Large non-functioning adenomas also lead to hyperprolactinemia but levels virtually never exceed 94 microg/l. Acquired and isolated prolactin deficiency is rare.

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“…Macroprolactinaemia (MPRL) is the condition which results when the high molecular mass forms (bPRL, bbPRL) are predominant. MPRL is classically associated with asymptomatic hyperprolactinaemia (3,4), though symptoms of hyperprolactinaemia have been described in some macroprolactinaemic patients (5,6,7,8,9). The prevalence of MPRL has been estimated at being between 10 and 45% in the hyperprolactinaemic population (2,5,6,10).…”

Section: Introductionmentioning

confidence: 99%

Macroprolactinaemia: a biological diagnostic strategy from the study of 222 patients

Parlant-Pinet

Harthé

Roucher

et al. 2015

European Journal of Endocrinology

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Objectives: Gel filtration chromatography (GFC), the gold standard for macroprolactinaemia (MPRL) diagnosis, is a slow, costly and labour-intensive method. To limit the number of GFC required, we evaluated two screening tests for MPRL: prolactin (PRL) recovery after polyethylene glycol (PEG) precipitation and PRL concentration ratio, derived from two assays, each having different big-big-PRL cross-reactivities. In some patients, MPRL is characterised by clinical symptoms which can be associated with an excess of monomeric PRL. We compared the monomeric PRL concentration obtained from GFC with the PRL concentration i) on a cobas e 601 analyser and ii) in the supernatant after PEG precipitation. Design and methods: We studied hyperprolactinaemic sera subjected to physician-ordered GFC, between February 2013 and July 2014. We performed PEG precipitation (to evaluate the PRL concentration and rate of recovery in the supernatant) and two PRL assays: RIA and electrochemiluminescent assay (ECLIA), on a Roche cobas e 601 analyser, and calculated the RIA/ECLIA ratio. Results: Among the 222 sera, we were able to diagnose or exclude MPRL in 72.1% of cases, based solely on the ratio and/or recovery. In the remaining cases, GFC was necessary for making a diagnosis. Elevated monomeric PRL was present in 10.9% of macroprolactinaemic sera. In the case of MPRL, both PRL measurements on the cobas analyser and in the supernatant weakly correlated with monomeric PRL values obtained from GFC. Conclusions: The combination of PEG and RIA/ECLIA ratio analysis reduced the number of necessary GFC. However, GFC is essential in MPRL cases to evaluate the monomeric PRL concentration.

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The Impact on Clinical Practice of Routine Screening for Macroprolactin

Abstract: Routine screening of all hyperprolactinemic sera for macroprolactin is recommended.

Cited by 131 publications

References 36 publications

Deep TMS on alcoholics: effects on cortisolemia and dopamine pathway modulation. A pilot study

Deep TMS on alcoholics: effects on cortisolemia and dopamine pathway modulation. A pilot study

Hyperprolactinemia

Macroprolactinaemia: a biological diagnostic strategy from the study of 222 patients

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