An Update on the Clinical Significance of Macroprolactinemia in Infertile Patients Presenting with Hyperprolactinemia: A Mini Review

Abstract

Hyperprolactinemia is a frequent presentation in case of patients with infertility. As many as 15-20% of women having irregular cycles possess hyperprolactinemia. Repression of the hypothalamo-pituitary-ovarian(H-P-O)axis through hampering of liberation of pulsatile gonadotropin-releasing hormone in view of hyperprolactinemia is a frequent endocrine cause of infertility. Previously we had reviewed prolactinomas in infertility as well as how do we treat prolactinomas in infertility in 2003&2005& highlighted the structure of macroprolactin besides treatment aspect. 3 kinds of human Prolactin(Prl) are existent-namely monomeric Prl, dimeric Prl as well as macro-Prl. Macro-Prl alias big-big Prl possesses a molecular weight(MW) of >150 kDa in addition to is implicated for 5-10%of circulating Prl in healthy subjects. In case of major kind of circulating Prl is macro-Prl, a diagnosis of macroprolactinemia gets established of the patients having hyperprolactinemia 10- 46% possess macroprolactinemia. In view of the need of ruling out a pituitary prolactinoma on finding escalated quantities of Prl-routinely as reproductive endocrinology & Infertility specialists(REI) we have a tendency of getting an imaging either as a CTScan or magnetic resonance imaging(MRI) for the same. However with the major work of the group of Hattori N, in the last 2-3 decades it has been emphasized how we need to first confirm that we don’t have macro- Prl for avoidance of unindicated investigations in case of macroprolactinemia leading to escalated blood tests, imaging as well as dopamine agonists treatment which puts extra burden of cost& stress of a tumor on the patients in case of this benign disorder.