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Prolactinoma
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Pituitary adenomas producing prolactin (prolactinomas, or lactotroph adenomas) are diagnosed by sustained non-pregnant elevation of serum prolactin (usually >40 μg/L × 2; normal prolactin non-pregnant: <20 μg/L) and radiographic (best is MRI) evidence of pituitary adenoma. Rule out other causes of prolactinemia (Table 8.1) [1, 2] and macroprolactinemia (a condition where more than 60% of circulating prolactin is made up of macroprolactin, a complex formed by IgG and monomeric prolactin that result in elevate serum prolactin but has low biological activity and usually requires no treatment) in all asymptomatic patients [3, 4].
Disorders
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
(Gupta et al., BJPsych Adv 2017; 23(40): 278–86) Measure prolactin in low stress environment, ≥2 h after waking and ≥1 h after eating.Two forms of prolactin: free prolactin (active) and macroprolactin (inactive). If ↑prolactin, check macroprolactin levels, as this may be causing pseudohyperprolactinaemia, which is not clinically significant.Often asymptomatic.Sequelae include gynaecomastia, galactorrhoea, sexual dysfunction, subfertility and osteoporosis.Weigh risks of ↑prolactin against risks of switching antipsychotic.
Treatment Options: I. Ovulation Induction
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
Selwyn P. Oskowitz, Alan S. Penzias
How do we explain the woman who has normal menstrual cycles in the presence of hyperprolactinemia? In addition to the biologically active monomeric prolactin, other larger prolactin species (termed macroprolactins) are present in the bloodstream. These macroprolactins are inactive and are of no clinical significance but are measured in the conventional prolactin assay. A macroprolactin level can be measured to determine the true circulating levels of bioactive monomeric prolactin. For this reason, routine screening of women with normal cycles and no complaints of galactorrhea should be discouraged.
The prevalence of hyperprolactinaemia in subfertile ovulatory women and its impact on fertility treatment outcome
Published in Journal of Obstetrics and Gynaecology, 2022
Maria Wojcik, Saad Amer, Kanna Jayaprakasan
The high prevalence of hyperprolactinaemia found in this study can be explained by a number of reasons. First, and perhaps most important is prolactin’s susceptibility to stress. This is something undoubtedly experienced by many subfertile women, going through the difficult process of fertility investigation and management. Second, we need to acknowledge that conditions such as polycystic ovary syndrome (PCOS) can be associated with the rise in prolactin. Although the relationship between the two remains unknown, a finding of hyperprolactinaemia among PCOS women is undoubtedly common (Robin et al. 2011). Finally, macroprolactin may also be behind the increased prolactin level. This corresponds to a phenomenon when molecules of prolactin clump together, forming what is known as macroprolactin, which falsely elevates the result (Gibney et al. 2005). Nevertheless, the laboratory responsible for investigating serum samples in this cohort screened the results for macroprolactin, thereby discounting any false positive results.
Hyperprolactinaemia in male infertility: Clinical case scenarios
Published in Arab Journal of Urology, 2018
Zeinab Dabbous, Stephen L Atkin
Secondly, macroprolactinaemia is hyperprolactinaemia due to excess macroprolactin with normal concentrations of monomeric prolactin [25]. Macroprolactin is a non-bioactive prolactin isoform usually composed of a prolactin monomer and an IgG molecule having a prolonged clearance rate similar to that of immunoglobulins. This isoform is clinically non-functional and therefore not of clinical significance, but it interferes with immunological assays used for the detection of prolactin that may give a falsely elevated prolactin result [26]. Therefore, macroprolactinaemia may lead to misdiagnosis and mismanagement of hyperprolactinaemic patients if not recognised. Current best practice recommends that all sera with elevated total prolactin concentrations are sub-fractionated using polyethylene glycol precipitation to provide an accurate measurement of the bioactive monomeric prolactin content [27].