Whyte M B, Pramodh S, Srikugan L, Gilbert J A, Miell J P, Sherwood R A, McGregor A M, Aylwin S J B
Department of Diabetes and Endocrinology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK,
Pituitary. 2015 Jun;18(3):319-25. doi: 10.1007/s11102-014-0576-7.
Recent guidelines suggest that a single prolactin measurement is adequate to confirm hyperprolactinaemia. This may lead to unnecessary investigation of artefactual hyperprolactinaemia. Prolactin measurement drawn from an indwelling cannula after rest removes stress as a confounding variable. The objective was to determine the frequency of true hyperprolactinaemia amongst patients referred following a single prolactin measurement.
A cannulated study was considered if prolactin on referral ('Referral Prolactin') was <5,500 mU/L (260 ng/mL) but >410 mU/L (19 ng/mL) in males or >510 mU/L (24 ng/mL) in females, irrespective of clinical context. Case-notes of 267 patients undergoing cannulated prolactin measurement over a 10-year period (2000-2010) were reviewed. Pre-existing pituitary disease, dopamine antagonist use, and macroprolactinaemia were excluded. Morning ante-cubital vein cannulation was followed immediately by withdrawal of 'Repeat Prolactin' sample. After 120-min bed-rest, 'Resting Prolactin' was withdrawn through the cannula.
235 patients were included for analysis. 64 (27%) were within normal range; following Repeat Prolactin in 41 (17%) and Resting Prolactin in 23 (9%) cases. Referral Prolactin was higher in patients with true hyperprolactinaemia, 1,637 ± 100 mU/L (77.2 ± 4.7 ng/mL) than with artefactual hyperprolactinaemia, 1,122 ± 68 mU/L (52.9 ± 3.2 ng/mL; P < 0.001) but there was substantial overlap. 21 out of 171 cases (12%) with true hyperprolactinaemia had a macroadenoma. Presenting symptoms did not predict true hyperprolactinaemia. Referral Prolactin of 2,000 mU/L (94 ng/mL) had 97% specificity to identify true hyperprolactinaemia.
Reliance on a single, non-rested prolactin value may lead to over-diagnosis of hyperprolactinaemia. A resting sample should be considered with random values <2,000 mU/L (94 ng/mL).
近期指南表明，单次催乳素测量足以确诊高催乳素血症。这可能导致对假性高催乳素血症进行不必要的检查。静息后通过留置套管采集的催乳素测量值可消除应激这一混杂变量的影响。目的是确定单次催乳素测量后转诊患者中真性高催乳素血症的发生率。
如果转诊时的催乳素（“转诊催乳素”）男性<5500 mU/L（260 ng/mL）但>410 mU/L（19 ng/mL），女性>510 mU/L（24 ng/mL），无论临床情况如何，均纳入套管研究。回顾了2000年至2010年期间267例接受套管催乳素测量患者的病历。排除既往垂体疾病、多巴胺拮抗剂使用情况和巨催乳素血症。早晨在前臂肘前静脉进行套管置入后，立即采集“重复催乳素”样本。卧床休息120分钟后，通过套管采集“静息催乳素”样本。
235例患者纳入分析。64例（27%）在正常范围内；重复催乳素测量后41例（17%）正常，静息催乳素测量后23例（9%）正常。真性高催乳素血症患者的转诊催乳素水平（1637±100 mU/L，77.2±4.7 ng/mL）高于假性高催乳素血症患者（1122±68 mU/L，52.9±3.2 ng/mL；P<0.001），但有大量重叠。171例真性高催乳素血症患者中有21例（12%）患有大腺瘤。出现的症状不能预测真性高催乳素血症。转诊催乳素水平为2000 mU/L（94 ng/mL）时，识别真性高催乳素血症的特异性为97%。
仅依赖单次非静息状态下的催乳素值可能导致高催乳素血症的过度诊断。对于随机值<2000 mU/L（94 ng/mL）的情况，应考虑采集静息样本。
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