Frequency of Macroprolactin in Hyperprolactinemia

Journal of the College of Physicians and Surgeons Pakistan

article

Noreen Abbas Sherazi¹  Mirza Zain Baig²  Aysha Habib Khan³ 

[1] Department of Clinical Chemistry and Immunology, Chughtai Laboratory;Medical Student, The Aga Khan University;Department of Pathology and Laboratory Medicine, The Aga Khan University

关键词: MaPRL;    PEG precipitation;    True hyperprolactinemia;    Oligomenorrhea.;   

学科分类：医学（综合）

来源: College of Physicians and Surgeons Pakistan. Journal

【 摘 要 】

Objective: To determine the frequency of Macroprolactin (MaPRL) in patients with increased total prolactin and its clinicaland financial impact.Study Design: Cross-sectional study.Place and Duration of Study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The AgaKhan University Hospital, Karachi, from March to May 2015.Methodology: Patients with high total prolactin were screened by polyethylene glycol (PEG) precipitation for determinationof MaPRL. Clinical history, imaging work-ups, and cost incurred in further investigations were collected by telephonic interviewafter verbal consent. Patients were stratified into true hyperprolactinemia and macroprolactinemia after PEG treatment,based on monomeric prolactin levels. Medical records of cases registered with AKUH were reviewed to confirm the diagnosis.Results: Two hundred and thirty-nine patients were identified with high prolactin levels. Macroprolactinemia was identifiedin 145 (60.7%) and true hyperprolactinemia in 94 (39.3%) patients. Galactorrhea was significantly more in truehyperprolactinemic females (p=0.022), followed by visual disturbances (p=0.01) and headache (p=0.006). Moreover, asmajority of population were females, the clinical features in the macroprolactinemia group as compared to truehyperprolactinemic group were mostly related to non-pituitary causes like drug intake [42.5% (54) vs. 37% (30)], heatintolerance due to thyroidal illness [41.7% (53) vs. 38.3% (31)] and surgery [26.8% (34) vs 22.2% (18)] in females. Furtherradiological workup (MRI, CT) were conducted in 35 (37.2%) patients with true hyperprolactinemia. Twenty-one (60%) ofthe patients were confirmed to have pituitary adenomas. In eight (5.5%) patients with MaPRL, only one had pituitary microadenoma on radiological workup. Total cost impact on the basis of investigations, was significantly higher in the groupundergone imaging, despite 7 out of 8 individuals found to have normal imaging results. The median total cost in truehyperprolactinemic group undergone imaging was Rs. 4370 (IQR=2412.5, 22850) as compared to macroprolactinemicgroups; Rs. 3,250 (IQR=2150, 4278). There was significant difference in the cost burden of both the groups (p <0.001).Conclusion: High frequency of MaPRL was identified in patients with hyperprolactinemia. Screening with PEGprecipitation in hyperprolactinemic sera is simple and cost-effective.

【 授权许可】

CC BY