Abstract
This article provides a brief review of macroprolactin (MPRL) – what, why, how, and when. Prolactin (PRL) secretion is uniquely controlled by tonic dopamine inhibition. Circulating PRL is a heterogeneous mixture of different sized proteins – monomer, dimer, and a large PRL-immunoglobulin aggregate also known as MPRL. Hyperprolactinemia (HPRL), which affects male sexual function and female reproduction, is a common endocrine disorder. Elevated PRL may be physiologic, pharmacologic, or pathologic. However, MPRL is quite common (ranging from 13–30%) and should be excluded before inappropriate investigations and therapy for HPRL are initiated. MPRL can be precipitated by mixing serum with polyethylene glycol (PEG) followed by centrifugation; monomeric PRL remains in the supernatant. MPRL is considered present if the PRL recovery is less than 40% or if the post-precipitation PRL concentration is low. The use of both measures for MPRL provides greater clarity. Different immunoassay platforms recognize MPRL differently necessitating assay-specific reference ranges. All HPRL samples should be screened for MPRL.
Highlights
Prolactin (PRL) is unique among hormones in endocrinology in that its secretion is constantly under tonic inhibition by dopamine from the hypothalamus
Dopamine interacts with pituitary lactotroph receptors to produce inhibitory Gproteins causing diminished adenyl cyclase levels, decreased cyclic-adenosine monophosphate, and low Citation: Lau CS, Aw TC
Post-polyethylene glycol (PEG)-PRL reference ranges may be able to detect true HPRL coexisting with MPRL
Summary
Prolactin (PRL) is unique among hormones in endocrinology in that its secretion is constantly under tonic inhibition by dopamine from the hypothalamus. MPRL is a complex formed by monomeric PRL and IgG anti-prolactin auto-antibodies non-IgG variants do exist. The prevalence of HPRL is about 10/100,000 in men and 30/100,000 in women. HPRL commonly causes amenorrhea/infertility in women [1, 8] while its effects in men are more subtle and insidious (sexual dysfunction).
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