Cattaneo F A, Fahie-Wilson M N
Department of Endocrinology and Diabetology, University Hospital of Berne, Switzerland.
J Neurosurg. 2001 Aug;95(2):334-7. doi: 10.3171/jns.2001.95.2.0334.
The authors report the case of a 37-year-old woman who presented with amenorrhea and an increased level of serum prolactin. Magnetic resonance images of the pituitary revealed a lesion with characteristics consistent with those of a microadenoma. Transsphenoidal exploration was performed, but a prolactinoma was not found. After endocrinological review, the patient's hyperprolactinemia was found to be caused by the presence of macroprolactin and her amenorrhea was due to intense exercise and low body weight. Macroprolactin is an isoform of prolactin that is variably reactive in assays for prolactin, but displays minimum bioactivity in vivo. Patients with macroprolactin are mostly asymptomatic. This phenomenon may cause elevated prolactin values, which the authors view as apparent hyperprolactinemia. The presence of macroprolactin is an underrecognized problem, occurring in as many as 15 to 20% of patients with elevated prolactin values and often leading to unnecessary, expensive diagnostic procedures and inappropriate treatment. The presence of macroprolactin should always be suspected when the patient's clinical history or clinical or radiological data are incompatible with the prolactin value. Physicians dealing with diagnosis and treatment of hyperprolactinemia (general practitioners, gynecologists, neurosurgeons, endocrinologists, and biochemists) should be aware of the potentially misleading nature of macroprolactin.
作者报告了一例37岁女性病例，该患者出现闭经且血清催乳素水平升高。垂体磁共振成像显示有一个病变，其特征与微腺瘤一致。进行了经蝶窦探查，但未发现催乳素瘤。在内分泌学复查后，发现该患者的高催乳素血症是由大分子催乳素的存在引起的，其闭经是由于剧烈运动和体重过低。大分子催乳素是催乳素的一种异构体，在催乳素检测中反应性各异，但在体内显示出最小的生物活性。大分子催乳素患者大多无症状。这种现象可能导致催乳素值升高，作者将其视为明显的高催乳素血症。大分子催乳素的存在是一个未被充分认识的问题，在催乳素值升高的患者中发生率高达15%至20%，常常导致不必要的、昂贵的诊断程序和不恰当的治疗。当患者的临床病史或临床及影像学数据与催乳素值不相符时，应始终怀疑大分子催乳素的存在。处理高催乳素血症诊断和治疗的医生（全科医生、妇科医生、神经外科医生、内分泌学家和生物化学家）应意识到大分子催乳素可能具有误导性。
