Skip to main content
SpringerLink
Log in

Macroprolactinemia in hyperprolactinemic infertile women

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Hyperprolactinemia occurs in 15–20 % of women with menstrual disturbances and 30–40 % of infertile women and it can adversely affect the fertility. High molecular weight prolactin (macroprolactin) has long been known in hyperprolactinemic fertile women. However, the prevalence of macroprolactinemia in hyperprolactinemic infertile women is not known. This cross-sectional study was carried out during the period of June 2010 and June 2011 at a single tertiary care centre. All women who attended the infertility clinic during this period were screened for hyperprolactinemia and only women with hyperprolactinemia and infertility were further studied for the presence of macroprolactin by polyethylene glycol precipitation assay. We compared the clinical, hormonal profile and fertility outcome of infertile women with true hyperprolactinemia and macroprolacinemia using appropriate statistical tests. Of 1,163 infertile women, 183 (15.7 %) had hyperprolactinemia [134 (73 %) had primary infertility and 49 (27 %) had secondary infertility]. Out of these 183 women with hyperprolactinemia, one had microadenoma, 161 had true idiopathic hyperprolactinemia and 21 (11.5 %) women had macroprolactinemia. The prevalence of oligomenorrhea and galactorrhea were significantly higher in patients with true hyperprolactinemia than macroprolactinemia (46 vs. 14 %, p < 0.008 and 30 vs. 5 %, p = 0.01 respectively). Twenty-two patients (13.5 %) of true hyperprolactinemia and two (9 %) in macroprolactinemia became pregnant during the study period. Prolactin measurement should be a part of routine evaluation of couples referred to infertility clinics. Macroprolactin screening is mandatory when clinical features and serum PRL assay results are conflicting. Patients with macroprolactinemia should be investigated for causes of infertility other than hyperprolactinemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. T. Mancini, F.F. Casanueva, A. Giustina, Hyperprolactinemia and prolactinomas. Endocrinol. Metab. Clin. North Am. 37, 67–99 (2008)

    Article  PubMed  CAS  Google Scholar 

  2. J.V. Kredentser, C.F. Hoskins, J.Z. Scott, Hyperprolactinemia—a significant factor in female infertility. Am. J. Obstet. Gynecol. 139, 264–267 (1981)

    PubMed  CAS  Google Scholar 

  3. G.S. Wand, Diagnosis and management of hyperprolactinemia. Endocrinologist 13(1), 52–57 (2003)

    Article  Google Scholar 

  4. H.K. Suh, A.G. Frantz, Size heterogeneity of human prolactin in plasma and pituitary extracts. J. Clin. Endocrinol. Metabol. 39, 928–935 (1974)

    Article  CAS  Google Scholar 

  5. J.B. Josimovich, M.A. Lavenhar, M.M. Devanesan, H.J. Sesta, S.A. Wilchins, A.C. Smith, Heterogeneous distribution of serum prolactin values in apparently healthy young women, and the effects of oral contraceptive medication. Fertil. Steril. 47, 785–791 (1987)

    PubMed  CAS  Google Scholar 

  6. V. Leite, H. Cosby, L.G. Sobrinho, M.A. Fresnoza, M.A. Santos, H.G. Friesen, Characterization of big, big prolactin in patients with hyperprolactinemia. Clin Endocrinol (Oxf) 37, 365–372 (1992)

    Article  CAS  Google Scholar 

  7. F. Donadio, A. Barbieri, R. Angioni, G. Mantovani, P. Beck-Peccoz, A. Spada, A.G. Lania, Patients with macroprolactinaemia: clinical and radiological features. Eur. J. Clin. Invest. 37, 552–557 (2007)

    Article  PubMed  CAS  Google Scholar 

  8. M.D. Bronstein, Editorial: is macroprolactinemia just a diagnostic pitfall? Endocrine 41, 169–170 (2012)

    Article  PubMed  CAS  Google Scholar 

  9. T.P. Smith, A.M. Suliman, M.N. Fahie-Wilson et al., Gross variability in the detection of prolactin in sera containing big prolactin (macroprolactin) by commercial immunoassays. J. Clin. Endocrinol. Metabol. 87, 5410–5415 (2002)

    Article  CAS  Google Scholar 

  10. J.G.H. Vieira, T.T. Tachibana, L.H. Obara, R.M.B. Maciel, Extensive experience and validation of polyethylene glycol precipitation as a screening method for macroprolactinemia. Clin. Chem. 44, 1758–1759 (1998)

    PubMed  CAS  Google Scholar 

  11. A. Olukoga, J. Kane, Macroprolactinaemia: validation and application of the polyethylene glycol precipitation test and clinical characterization of the condition. Clin Endocrinol (Oxf) 51, 119–126 (1999)

    Article  CAS  Google Scholar 

  12. M. Fahie-Wilson, P. Brunsden, J. Surrey, A. Everitt, Macroprolactin and the Roche Elecsys prolactin assay: characteristics of the reaction and detection by precipitation with polyethylene glycol. Clin. Chem. 46, 1993–1995 (2000)

    PubMed  CAS  Google Scholar 

  13. M.N. Fahie-Wilson, J.A. Ahlquist, A.R. Ellis, Three decades of clinical follow-up in 271 women with hyperprolactinaemia; macroprolactinaemia should be considered. Clin. Endocrinol. 64, 226 (2006)

    Article  Google Scholar 

  14. S. Isik, D. Berker, Y.A. Tutuncu, U. Ozuguz, F. Gokay, S. Guler et al., Clinical and radiological findings in macroprolactinemia. Endocrine 41, 327–333 (2012)

    Article  PubMed  CAS  Google Scholar 

  15. H. Leslie, C. Courtney, P. Bell et al., A laboratory and clinical experience in 55 patients with macroprolactinemia identified by a simple polyethylene glycol precipitation method. J. Clin. Endocrinol. Metab. 86, 2743–2746 (2001)

    Article  PubMed  CAS  Google Scholar 

  16. Practice Committee of the American Society for Reproductive Medicine, Definitions of infertility and recurrent pregnancy loss. Fertil Steril 90, S60 (2008)

    Google Scholar 

  17. N. Hattori, C. Inagaki, Anti-prolactin (PRL) autoantibodies cause asymptomatic hyperprolactinemia: bioassay and clearance studies of PRL-immunoglobulin G complex. J. Clin. Endocrinol. Metab. 82, 3107–3110 (1997)

    Article  PubMed  CAS  Google Scholar 

  18. M. Fahie-Wilson, S. Soule, Macroprolactinaemia: contribution to hyperprolactinaemia in a district general hospital and evaluation of a screening test based on precipitation with polyethylene glycol. Ann. Clin. Biochem. 34, 252–258 (1997)

    PubMed  CAS  Google Scholar 

  19. A. Alfonso, K.I. Rieniets, R.A. Vigersky, Incidence and clinical significance of elevated macroprolactin levels in patients with hyperprolactinemia. Endocr Pract 12, 275–280 (2006)

    Article  PubMed  Google Scholar 

  20. S. Vallette-Kasic, I. Morange-Ramos, A. Selim et al., Macroprolactinemias revisited: a study on 106 patients. J. Clin. Endocrinol. Metab. 587, 581–588 (2002)

    Article  Google Scholar 

  21. G. Tamer, A. Telci, M. Mert, A.K. Uzum, F. Aral, F. Alagol, Prevalence of pituitary adenomas in macroprolactinemic patients may be higher than it is presumed. Endocrine 41, 138–143 (2012)

    Article  PubMed  CAS  Google Scholar 

  22. T. Bjoro, L. Morkrid, R. Wergeland et al., Frequency of hyperprolactinemia due to large molecular weight prolactin (150–170 kD PRL). Scand. J. Clin. Lab. Invest. 55, 139–147 (1995)

    Article  PubMed  CAS  Google Scholar 

  23. N. Hattori, T. Ishihara, K. Ikekubo, K. Moridera, M. Hino, H. Kurahachi, Autoantibody to human prolactin in patients with idiopathic hyperprolactinemia. J. Clin. Endocrinol. Metab. 75, 1226–1229 (1992)

    Article  PubMed  CAS  Google Scholar 

  24. F.F. Casanueva, M.E. Molitch, J.A. Schlechte et al., Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol (oxf) 65, 265–273 (2006)

    Article  Google Scholar 

Download references

Acknowledgments

We are thankful to Miss Pooja Kundal for manuscript typing and edition.

Conflict of interest

No conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Krithika Thirunavakkarasu, Lakhbir Dhaliwal, G. R. V. Prashad & Shalini Gainder

  2. Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Pinaki Dutta, Subbiah Sridhar, Naresh Sachdeva & Anil Bhansali

Authors
  1. Krithika Thirunavakkarasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pinaki Dutta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Subbiah Sridhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lakhbir Dhaliwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. R. V. Prashad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shalini Gainder
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naresh Sachdeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anil Bhansali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lakhbir Dhaliwal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thirunavakkarasu, K., Dutta, P., Sridhar, S. et al. Macroprolactinemia in hyperprolactinemic infertile women. Endocrine 44, 750–755 (2013). https://doi.org/10.1007/s12020-013-9925-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-013-9925-y

Keywords

Search

Navigation