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. 2024 Sep 11:68:e230391.
doi: 10.20945/2359-4292-2023-0391. eCollection 2024.

Usefulness of prolactin levels in predicting the etiology of hyperprolactinemia in a cohort of 770 patients

Lucio Vilar  1   2 , Clarice Freitas Vilar  2 , Ruy Lyra  1 , Luciano Albuquerque  1 , Ana Carolina Thé Garrido  1 , Patrícia Sampaio Gadelha  1 , Erik Trovão Diniz  1 , Marcos Almeida  1 , Lucia Helena Cordeiro  1 , Erico Higino de Carvalho  1 , Ana Teresa Bezerra de Melo  1 , Karoline Matias Medeiros  1 , Gabriel Rodrigues de Assis Ferreira  1 , José Coelho Mororó  1 , Daniela Zago Ximenes  1 , Camila Ribeiro Coutinho Madruga  1 , Rosália de Oliveira Nunes  1 , Yanna Queiroz Pereira de Sá  1 , Luciana Ansaneli Naves  3
Affiliations

Usefulness of prolactin levels in predicting the etiology of hyperprolactinemia in a cohort of 770 patients

Lucio Vilar et al. Arch Endocrinol Metab. .

Abstract

Objective: Determining the etiology of hyperprolactinemia is fundamental for selecting the most appropriate treatment strategy. The aim of this study was to evaluate the usefulness and accuracy of prolactin levels in predicting the etiology of nonphysiological hyperprolactinemia.

Subjects and methods: In this retrospective study, we reviewed medical records of patients with nonphysiological hyperprolactinemia seen at two neuroendocrine reference centers located in Recife, Brazil, from January 2000 to December 2019.

Results: The study included 770 patients aged 12-73 years (65% female). The three most frequent etiologies of hyperprolactinemia were prolactinomas (n = 263; 34.2%), drug-induced hyperprolactinemia (n = 160; 20.8%), and macroprolactinemia (n = 120; 15.6%). The highest mean prolactin levels were observed in cases of prolactinomas and idiopathic hyperprolactinemia. Most patients with hyperprolactinemia due to other etiologies had prolactin levels < 100 ng/mL, but these levels were also found in 16.5% of patients with microproplactinomas and in 20% of those with idiopathic hyperprolactinemia. Likewise, prolactin levels largely overlapped among patients with microprolactinomas, macroprolactinemia, and drug-induced hyperprolactinemia. Notably, prolactin levels > 250 ng/mL enabled a clear distinction between the etiologies of macroprolactinoma and nonfunctioning pituitary adenoma. Moreover, prolactin levels > 500 ng/mL were highly suggestive of macroprolactinomas, although they were also found in very few patients (<2%) with microprolactinomas or drug-induced hyperprolactinemia.

Conclusion: Despite considerable overlap in prolactin levels among the different etiologies of hyperprolactinemia, values > 250 ng/mL allowed a clear distinction between macroprolactinomas and nonfunctioning pituitary adenomas. Furthermore, prolactin levels > 500 ng/mL were almost exclusively found in patients with prolactinomas.

Keywords: Prolactin; hyperprolactinemia; macroprolactinoma; microprolactinoma; prolactin-secreting pituitary adenoma.

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Conflict of interest statement

Disclosure: no potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. Coronal (left) and sagittal (right) magnetic resonance imaging of the pituitary in a 28-year-old female patient with a prolactin level of 343 ng/mL and a 2.8 cm macroadenoma (arrows) that was initially labeled a cabergoline-resistant prolactinoma. After polyethylene glycol (PEG) precipitation, the prolactin level decreased to 27.1 ng/mL (normal range < 29 ng/mL). The patient received a final diagnosis of gonadotroph pituitary adenoma associated with macroprolactinemia.
Figure 2
Figure 2. Clinical features of 100 women with macroprolactinemia.
Figure 3
Figure 3. Coronal magnetic resonance imaging of the pituitary showing a giant prolactinoma (6.4 cm) in a patient with falsely low serum prolactin level (91 ng/mL) due to the high-dose hook effect. The prolactin level increased to 22,600 ng/mL after a 1:100 dilution of the serum sample.
See this image and copyright information in PMC

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