SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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M Trummler1 , F Simmler2

1Bio-Analytica, medical laboratory, Maihofstr.95a,6006 Lucerne, 2Central laboratory, clinical chemistry, cantonal hospital Lucerne

Problem
Prolactin circulates in the plasma in monomeres, dimeres („big prolactin“) and multimeres/Ig-complexes („big big prolactin“ or „macroprolactin“). The different analytical systems used in the medical routine laboratory detect macroprolactin with different sensitivity (1), that means that falsely high values can be measured. Patients with a hyperprolactinemia which is due to mainly macroprolactin will unnecessarily undergo many diagnostic procedures which can be uncomfortable to tolerate and surely are expensive. Therefore the medical laboratory should be capable to differentiate between a real hyperprolactinemia and a „macrohyperprolactinemia“. As a goldstandard serves a gel filtration chromatography which is time-consuming, costly and beyond the scope of most clinical laboratories (2).
Methods
50 patients have been recruited from the ambulatory endocrinological and gynecological service of the cantonal hospital of lucerne, the cantonal psychiatric clinic St. Urban and from the medical laboratory Bio-Analytica in Lucerne. They all showed a hyperprolactinemia measured on Elecsys 2010 (Roche Diagnostics) and/or ADVIA Centaur (Bayer). The prolactin values have been compared between the two systems before and after treatment with PEG 6000 25%, which can replace the gel-chromatography in routine use (3) and a retrospective correlation with clinical data has been done.
Results and Conclusion
The Elecsys 2010 showed more crossreactivity to macroprolactin than the Centaur does. The Roche company recommends in the package insert to treat hyperprolactinemic samples with PEG to avoid falsely elevated values due to macroprolactin. The presence of macroprolactin was not associated with relevant pathological findings.
References
1 Rhis John et al. Clin Chem 2000;46:884-5
2 Schlechte Janet JCEM 2002;87:5408-9
3 Fahie-Wilson et al. Ann Clin Biochem 1997;34:252-8

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