Sadideen H, Swaminathan R
Department of Chemical Pathology, Guy's and St Thomas' NHS Trust, London, UK.
Int J Clin Pract. 2006 Apr;60(4):457-61. doi: 10.1111/j.1368-5031.2006.00732.x.
Monomeric prolactin (PRL) of molecular weight 23 kDa constitutes up to 95% of adult serum PRL. Macroprolactin is a large antigen-antibody complex of molecular weight greater than 100 kDa and constitutes less than 1% of circulating PRL. Thus, in most cases, hyperprolactinaemia is usually a result of high levels of monomeric PRL, which may be due to excess production as with a prolactinoma or due to disinhibition by compression of the pituitary stalk. Nevertheless, it must be noted that macroprolactinaemia may be a cause of hyperprolactinaemia in some individuals, which may have no association with any pathology. The presence of macroprolactin should always be suspected when a patient's clinical history and/or radiological data are incompatible with his/her PRL value. Thus, it may be useful to screen all patients with high sera PRL levels in order to prevent unnecessary investigations into the cause for hyperprolactinaemia. This has recently been facilitated with the advent of simple laboratory tests such as the polyethyleneglycol precipitation method, although gel filtration chromatography remains the gold standard. It is hoped that macroprolactinaemia is included in the differential diagnosis of hyperprolactinaemia.
分子量为23 kDa的单体催乳素（PRL）占成人血清PRL的95%。大催乳素是一种分子量大于100 kDa的大抗原-抗体复合物，占循环PRL的比例不到1%。因此，在大多数情况下，高催乳素血症通常是单体PRL水平升高的结果，这可能是由于催乳素瘤导致的分泌过多，或者是由于垂体柄受压解除抑制所致。然而，必须注意的是，大催乳素血症在某些个体中可能是高催乳素血症的原因，且可能与任何病理情况无关。当患者的临床病史和/或影像学数据与PRL值不相符时，应始终怀疑存在大催乳素血症。因此，对所有血清PRL水平升高的患者进行筛查可能是有用的，以避免对高催乳素血症的病因进行不必要的检查。随着简单实验室检测方法如聚乙二醇沉淀法的出现，这一点最近变得更加容易，尽管凝胶过滤色谱法仍然是金标准。希望大催乳素血症能纳入高催乳素血症的鉴别诊断中。
