Clinical diagnostic aspects of macroprolactinemia

Macroprolactinemia (MP) that shows a discrepancy between its clinical symptoms and the level of prolactin (PRL) has recently aroused considerable interest among physicians of various specialties since not the whole PRL is biologically active. In this connection, its diagnosis is an urgent problem. This study was undertaken to reveal high molecular-weight or big-big PRL in patients with hyperprolactinemia of various genesis and to elucidate its clinical value. A total of 3S7 patients with hyperprolactinemia (PRL > 700 m U/l), including 34 males and 353 females, were examined. In all the patients, biologically active monomeric PRL was quantified via PEG 6000 treatment. Analysis of the findings indicated that MP was present in 19% of cases. Out of them, only 17 examinees had clinical symptoms of the disease. The remaining 56 patients were observed to have no clinical symptoms of hyperprolactinemia and to require no therapy. According to the obtained results, MP occurs in 19% of the patients with hyperprolactinemia. The determination of biologically active PRL and the calculation of big-big PRL in hyperprolactinemia are of great diagnostic value. Precipitation using PEG is the most informative, accessible, and cost-effective technique for estimating biologically active monomeric PRL in clinical practice. Therapy for MP is indicated only in cases of the increased fraction of biologically active PRL.

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