Hattori Naoki
Department of Pharmacology, Kansai Medical University, Osaka 570-8506, Japan.
J Pharmacol Sci. 2003 Jul;92(3):171-7. doi: 10.1254/jphs.92.171.
Hyperprolactinemia is not only seen in pregnancy but also in several pathological conditions such as prolactin (PRL) secreting pituitary adenoma (prolactinoma), intracranial tumors compressing the pituitary stalk or hypothalamus, and PRL stimulative drugs. However, some patients with hyperprolactinemia are diagnosed as having idiopathic hyperprolactinemia because the causes are unknown. They are subjected to repeated radiological examinations to find a microadenoma, to a long-term treatment with bromocriptine, and even to a surgical intervention. There is accumulating evidence that macroprolactinemia, in which most circulating PRL forms large protein complexes (more than 150 kDa), is a major cause of idiopathic hyperprolactinemia. The patients with macroprolactinemia are clinically characterized by the lack of hyperprolactinemia-related symptoms such as amenorrhea and galactorrhea. We found that anti-PRL autoantibody is a leading cause of macroprolactinemia that might be heterogeneous in nature. Most patients with anti-PRL autoantibodies were symptom-free and pregnancy was possible despite a marked hyperprolactinemia. Identification of macroprolactinemia is clinically important to prevent unnecessary examinations and treatments in patients with idiopathic hyperprolactinemia.
高催乳素血症不仅见于妊娠，还见于多种病理状况，如分泌催乳素（PRL）的垂体腺瘤（催乳素瘤）、压迫垂体柄或下丘脑的颅内肿瘤以及刺激PRL分泌的药物。然而，一些高催乳素血症患者因病因不明而被诊断为特发性高催乳素血症。他们需要反复接受影像学检查以寻找微腺瘤，接受溴隐亭长期治疗，甚至接受手术干预。越来越多的证据表明，大分子催乳素血症是特发性高催乳素血症的主要原因，在大分子催乳素血症中，大多数循环中的PRL形成大的蛋白质复合物（超过150 kDa）。大分子催乳素血症患者的临床特征是缺乏与高催乳素血症相关的症状，如闭经和溢乳。我们发现抗PRL自身抗体是大分子催乳素血症的主要原因，其性质可能是异质性的。大多数抗PRL自身抗体患者无症状，尽管催乳素血症明显，但仍有可能怀孕。识别大分子催乳素血症对于防止特发性高催乳素血症患者进行不必要的检查和治疗具有重要临床意义。
