Cross-reactivity in assays for prolactin and optimum screening policy for macroprolactinaemia

Author:

Smith Thomas P.1,Kelly Sinead1,Fahie-Wilson Michael N.2

Affiliation:

1. Department of Investigative Endocrinology , St. Vincent’s University Hospital , Dublin , Ireland

2. Clinical Biochemist , retired , Chiltern House, Bury St Edmonds , Suffolk , UK

Abstract

Abstract Objectives Macroprolactin cross-reacts in immunoassays for prolactin causing apparent hyperprolactinaemia (macroprolactinaemia) and consequent misdiagnosis and mismanagement of patients. Methods We determined the prevalence of macroprolactinaemia using prolactin immunoassays with reported “high” (Tosoh) or “low” cross-reactivity (Roche) with macroprolactin. We additionally modelled the effects of increasing the screening threshold on workload and sensitivity in the detection of macroprolactinaemia. Results A review of routine requests for prolactin received in a 12 month period identified 670 sera with hyperprolactinaemia (Tosoh assay). Treatment with polyethylene glycol (PEG) precipitation demonstrated normal levels of monomeric prolactin in 165 sera (24.6%) indicating macroprolactinaemia. In the macroprolactinaemic cohort, total prolactin levels were lower with the Roche assay (473 ± 132 mU/L; mean ± SD) compared to the Tosoh assay (683 ± 217 mU/L), p < 0.005. The prevalence of macroprolactinaemia was also lower with the Roche assay (6.2%). The number of samples that required screening for macroprolactinaemia fell by 14% when Roche gender specific total prolactin reference limits were applied. Use of a higher screening threshold (700 mU/L) reduced the screening workload considerably (Roche by 45%, Tosoh by 37%) however, the sensitivity of detection of macroprolactinaemia decreased markedly (Roche 90%, Tosoh 59%). Conclusions Macroprolactin interferes in both Tosoh and Roche prolactin immunoassays. Use of an assay with a relatively low cross reactivity with macroprolactin, e.g. Roche, will lead to a modest reduction in the screening workload. Increasing the screening threshold above the upper limit of the assay reference interval will also reduce the screening workload but leads to disproportionate increases in the number of cases of macroprolactinaemia which are missed.

Publisher

Walter de Gruyter GmbH

Subject

Biochemistry (medical),Clinical Biochemistry,General Medicine

Cited by 4 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Macroprolactin in mothers and their babies: what is its origin?;Clinical Chemistry and Laboratory Medicine (CCLM);2024-04-30

2. Reply to the Letter of Sun et al. [1] relating to Clin Chem Lab Med 2022;60(9):1365–72;Clinical Chemistry and Laboratory Medicine (CCLM);2022-09-05

3. Letter to the Editor relating to Clin Chem Lab Med 2022;60(9):1365–72;Clinical Chemistry and Laboratory Medicine (CCLM);2022-09-02

4. Interference by macroprolactin in assays for prolactin: will the In Vitro Diagnostics Regulation lead to a solution at last?;Clinical Chemistry and Laboratory Medicine (CCLM);2022-06-15

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