Abstract
Macroprolactin or big-big prolactin, is a high molecular weight prolactin-IgG complex which is, at least partly, measured by commercial immunoassays and can cause hyperprolactinemia. Polyethylene glycol (PEG) precipitation eliminates macroprolactin from serum but can also partly precipitate monomeric prolactin and big prolactin. Regarding monomeric prolactin measurements in the PEG supernatant, a specific threshold of hyperprolactinemia has to be determined. We measured prolactin with the Elecsys assay before and after, volume by volume, 25% PEG precipitation in 284 sera without hyperprolactinemia (prolactin <600 mIU/L) and without macroprolactinemia (PEG precipitation <40%). Monomeric prolactin was estimated by multiplying the prolactin measured in the PEG supernatant by 2. We also studied 178 hyperprolactinemic sera with macroprolactin (PEG precipitation >60%). The hyperprolactinemia threshold obtained from the 284 control sera was 475 mIU/L. Out of the 178 hyperprolactinemic sera, 16% had monomeric prolactin concentrations over this threshold. In conclusion, macroprolactin is not always the sole cause of hyperprolactinemia and monomeric prolactin should be estimated to avoid misdiagnosis.
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