Global Prevalence of Macroprolactinemia among Patients with Hyperprolactinemia: A Systematic Review and Meta-Analysis

Soh, Noor Azlin Azraini Che; Yaacob, Najib Majdi; Omar, Julia; Jelani, A M; Shafii, Noorazliyana; Ismail, Tuan Salwani Tuan; Azman, Wan Norlina Wan; Ghazali, Anis Kausar

doi:10.3390/ijerph17218199

Cited by 29 publications

(15 citation statements)

References 79 publications

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“…The overall global prevalence estimate of macroprolactin is 18.9% (95% CI: 15.8%, 22.1%) which necessitates screening for before investigating for causes of elevated prolactin. 10 …”

Section: Discussionmentioning

confidence: 99%

Utility of Cannulated Prolactin to Exclude Stress Hyperprolactinemia in Patients with Persistent Mild Hyperprolactinemia

Almazrouei

Zaman

Wernig

et al. 2021

Clin Med Insights Endocrinol Diabetes

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Background: Stress-induced hyperprolactinemia can be difficult to differentiate from true hyperprolactinema and may result in patients having unnecessary investigations and imaging. We report the results of cannulated prolactin tests with serial prolactin measurements from an indwelling catheter to differentiate true from stress-induced hyperprolactinemia in patients with persistently mildly elevated prolactin levels in both referral and repeat samples. Methods: Data were collected for 42 patients who had a cannulated prolactin test between January 2017 and May 2018. After cannula insertion, prolactin was measured at 0, 60, and 120 minutes. Normalization is defined as a decline in prolactin to gender-defined normal ranges. Results: The mean age was 33.8 years ( SD ± 9.9), and 37 (88%) were female. Menstrual irregularities were the main presenting symptom in 28.57% of the patients. Prolactin normalized in 12 (28.6%) patients of whom cannulated prolactin test was done. Repeat random prolactin levels were significantly higher in patients whose prolactin did not normalize during the cannulated prolactin test. MRI of the pituitary gland showed an abnormality in 23 out of 28 (82%) patients who did not normalize prolactin, a microadenoma in the majority of patients (18 patients). Conclusion: The cannulated prolactin test was useful in excluding true hyperprolactinemia in 28.6% of patients with previously confirmed mildly elevated random prolactin on two occasions, thus avoiding over-diagnosis and unnecessary imaging.

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“…The overall global prevalence estimate of macroprolactin is 18.9% (95% CI: 15.8%, 22.1%) which necessitates screening for before investigating for causes of elevated prolactin. 10 …”

Section: Discussionmentioning

confidence: 99%

Utility of Cannulated Prolactin to Exclude Stress Hyperprolactinemia in Patients with Persistent Mild Hyperprolactinemia

Almazrouei

Zaman

Wernig

et al. 2021

Clin Med Insights Endocrinol Diabetes

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“…Consistent with this finding, Soh and colleagues recently pooled data from 67 studies (n = 3770) and reported an overall prevalence of 18.9% for macroprolactinemia in patients with hyperprolactinemia [12]). However, the prevalence reported in this study is lower compared with the prevalence reported in other settings.…”

Section: Discussionmentioning

confidence: 73%

Relevance and Therapeutic Implication of Macroprolactinemia Detection Using PEG 6000 in Women of Childbearing-Age with Hyperprolactinemia: Experience of a Tertiary Hospital

Ongmeb¹,

Etoa²,

Mekobe³

et al. 2023

Ann Endocrinol Metab

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Introduction: Macroprolactin (MacroPRL), a variant of human prolactin, may interfere with hormonal assay and falsely increase serum prolactin levels. Therefore, failure to identify macroprolactinemia can lead to inappropriate investigations and treatment in women already susceptible to anxiety and stress. We aimed to identify macroprolactinemia among women of childbearing age with hyperprolactinemia. Materials and methods:We conducted a cross-sectional study in a tertiary care setting at the endocrine unit. Study participants were recruited from both endocrine and gynecological outpatient consultation services. They were women of childbearing age (18 to 49 years) consulting for signs and symptoms of gonadal dysfunction or hyperprolactinemia (PRL > 25 ng/ml). Total prolactin was measured using a Human direct ELISA method. Polyethylene glycol 6000 (PEG 6000) precipitation was used to detect macroprolactin. Results:We enrolled 33 women with a mean age of 31 ± 7 years (range 21-48). Twenty-seven (81.8%) participants were symptomatic, and the majority, 23/27 (69.7%) reported having galactorrhea, and 21 (63.4%) women reported having an irregular menstrual cycle. The median pre-precipitation prolactinemia reduced significantly after PEG precipitation from 61.2 (IQR: 33.2-115.9) ng/ml to 33.8 (IQR: 17.9-70.5) ng/ml, p < 0.001. After PEG precipitation 5 participants had a serum prolactin recovery rate below 60%, and therefore a prevalence of macroprolactinemia at 15.2%. Four out of five (80%) women with macroprolactinemia presented with symptoms which were (Amenorrhea, oligomenorrhea and galactorrhea). Conclusion:PEG 6000 permitted the detection of macroprolactinemia in women of childbearing age with hyperprolactinemia who otherwise would have been subjected to unnecessary medical investigations and treatment. Also, most of those with macroprolactin were symptomatic contrary to previous postulates.

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“…The prevalence of MP in our study was 8.3%. In a meta-analysis of 67 studies, the overall prevalence of MP was 19% but varied from 0 to 56% among the different studies [9]. This wide variability could largely be attributed to the difference in prolactin assays used in these studies.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Macroprolactinemia in Patients with Hyperprolactinemia Using Roche Elecsys Platform in a Large Tertiary Referral Center in UAE

Nuaimi¹,

Almazrouei²,

Othman³

et al. 2021

Dubai Diabetes Endocrinol J

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Objectives: Macroprolactin (macroPRL) excess is an important cause of hyperprolactinemia. Several prolactin assays have high reactivity to macroPRL. However, macroPRL screening is not routinely performed in many labs. This study aimed to evaluate the prevalence of macroprolactinemia (MP) in patients with elevated prolactin using the Roche Elecsys assay in a large tertiary center in UAE. Materials and Methods: Consecutive samples of patients with elevated prolactin presenting to Tawam Hospital from June to August 2018 were evaluated for MP. Polyethylene glycol (PEG) was used to precipitate macroPRL. Monomeric prolactin recovery cutoff ≤50% was used to determine the prevalence of MP. Results: A total of 180 patients with elevated prolactin were included in the study with a mean age of 33.1 ± 11.9 years. The majority were women (87.2%), and about 77.8% were newly diagnosed patients with hyperprolactinemia. The main indications for prolactin testing were menstrual irregularity (n = 121), infertility (n = 11), galactorrhea (n = 11), and sellar masses (n = 12). MP was present in 8.3% of the patients. The median (IQR) of total prolactin level was 740.5 (579–1,085) IU/m before PEG precipitation and was not significantly different between MP and true hyperprolactinemia cases. Three patients with MP had pituitary MRI evaluation, which was normal. Eight patients with MP were treated with cabergoline. Conclusion: One in 12 patients with hyperprolactinemia had MP on the Roche Elecsys assay defined as the cutoff recovery of ≤50% post-PEG precipitation. Physicians should be aware of the prolactin assay used in their labs, and we recommend routine macroPRL assessment in mild hyperprolactinemia samples in labs using the Roche Elecsys platform.

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Global Prevalence of Macroprolactinemia among Patients with Hyperprolactinemia: A Systematic Review and Meta-Analysis

Cited by 29 publications

References 79 publications

Utility of Cannulated Prolactin to Exclude Stress Hyperprolactinemia in Patients with Persistent Mild Hyperprolactinemia

Utility of Cannulated Prolactin to Exclude Stress Hyperprolactinemia in Patients with Persistent Mild Hyperprolactinemia

Relevance and Therapeutic Implication of Macroprolactinemia Detection Using PEG 6000 in Women of Childbearing-Age with Hyperprolactinemia: Experience of a Tertiary Hospital

Prevalence of Macroprolactinemia in Patients with Hyperprolactinemia Using Roche Elecsys Platform in a Large Tertiary Referral Center in UAE

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