Kasum Miro, Orešković Slavko, Čehić Ermin, Šunj Martina, Lila Albert, Ejubović Emina
Department of Obstetrics and Gynecology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
Department of Obstetrics and Gynecology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
Taiwan J Obstet Gynecol. 2017 Dec;56(6):719-724. doi: 10.1016/j.tjog.2017.10.002.
The role of macroprolactinemia in women with hyperprolactinemia is currently controversial and can lead to clinical dilemmas, depending upon the origin of macroprolactin, the presence of hyperprolactinemic symptoms and monomeric prolactin (PRL) levels. Macroprolactinemia is mostly considered an extrapituitary phenomenon of mild and asymptomatic hyperprolactinemia associated with normal concentrations of monomeric PRL and a predominance of macroprolactin confined to the vascular system, which is biologically inactive. Patients can therefore be reassured that macroprolactinemia should be considered a benign clinical condition, resistant to antiprolactinemic drugs, and that no diagnostic investigations or prolonged follow-up should be necessary. However, a significant proportion of macroprolactinemic patients appears to suffer from hyperprolactinemia-related symptoms and radiological pituitary findings commonly associated with true hyperprolactinemia. The symptoms of hyperprolactinemia are correlated to the levels of monomeric PRL excess, which may be explained as coincidental, by dissociation of macroprolactin, or by physiological, pharmacological and pathological causes. The excess of monomeric PRL levels in such cases is of primarily importance and the diagnosis of macroprolactinemia is misleading or inadequate. However, macroprolactinemia of pituitary origin associated with radiological findings of pituitary adenomas may rarely occur with similar hyperprolactinemic manifestations, exclusively due to bioactivity of macroprolactin. Therefore, in such cases with hyperprolactinemic signs and pituitary findings, macroprolactinemia should be considered a pathological biochemical condition of hyperprolactinemia. Accordingly, individualized diagnostic investigations with the introduction of dopamine agonists, or other treatment with prolonged follow-up, should be mandatory. The review analyses the laboratory and clinical significance of macroprolactinemia in hyperprolactinemic women suggesting clinically useful diagnostic and treatment strategies.
巨泌乳素血症在高泌乳素血症女性中的作用目前存在争议，并且可能导致临床困境，这取决于巨泌乳素的来源、高泌乳素血症症状的存在以及单体泌乳素（PRL）水平。巨泌乳素血症大多被认为是一种垂体外现象，与轻度无症状高泌乳素血症相关，单体PRL浓度正常，且巨泌乳素主要局限于血管系统，无生物学活性。因此，可以让患者放心，巨泌乳素血症应被视为一种良性临床状况，对抗泌乳素药物耐药，无需进行诊断性检查或长期随访。然而，相当一部分巨泌乳素血症患者似乎患有与高泌乳素血症相关的症状以及通常与真正的高泌乳素血症相关的垂体影像学表现。高泌乳素血症的症状与单体PRL过量水平相关，这可能被解释为巧合、巨泌乳素解离，或生理、药理和病理原因。在这些情况下，单体PRL水平的过量至关重要，而巨泌乳素血症的诊断具有误导性或不充分。然而，与垂体腺瘤影像学表现相关的垂体源性巨泌乳素血症可能很少出现类似的高泌乳素血症表现，完全是由于巨泌乳素的生物活性。因此，在这些有高泌乳素血症体征和垂体表现的病例中，巨泌乳素血症应被视为高泌乳素血症的一种病理性生化状况。相应地，引入多巴胺激动剂进行个体化诊断性检查或进行其他长期随访治疗应是必要的。本综述分析了高泌乳素血症女性中巨泌乳素血症的实验室和临床意义，提出了临床上有用的诊断和治疗策略。
