Sherazi Noreen Abbas, Baig Mirza Zain, Khan Aysha Habib
Department of Clinical Chemistry and Immunology, Chughtai Laboratory, Karachi.
Medical Student, The Aga Khan University, Karachi.
J Coll Physicians Surg Pak. 2018 Feb;28(2):93-97. doi: 10.29271/jcpsp.2018.02.93.
To determine the frequency of Macroprolactin (MaPRL) in patients with increased total prolactin and its clinical and financial impact.
Cross-sectional study.
Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from March to May 2015.
Patients with high total prolactin were screened by polyethylene glycol (PEG) precipitation for determination of MaPRL. Clinical history, imaging work-ups, and cost incurred in further investigations were collected by telephonic interview after verbal consent. Patients were stratified into true hyperprolactinemia and macroprolactinemia after PEG treatment, based on monomeric prolactin levels. Medical records of cases registered with AKUH were reviewed to confirm the diagnosis.
Two hundred and thirty-nine patients were identified with high prolactin levels. Macroprolactinemia was identified in 145 (60.7%) and true hyperprolactinemia in 94 (39.3%) patients. Galactorrhea was significantly more in true hyperprolactinemic females (p=0.022), followed by visual disturbances (p=0.01) and headache (p=0.006). Moreover, as majority of population were females, the clinical features in the macroprolactinemia group as compared to true hyperprolactinemic group were mostly related to non-pituitary causes like drug intake [42.5% (54) vs. 37% (30)], heat intolerance due to thyroidal illness [41.7% (53) vs. 38.3% (31)] and surgery [26.8% (34) vs 22.2% (18)] in females. Further radiological workup (MRI, CT) were conducted in 35 (37.2%) patients with true hyperprolactinemia. Twenty-one (60%) of the patients were confirmed to have pituitary adenomas. In eight (5.5%) patients with MaPRL, only one had pituitary microadenoma on radiological workup. Total cost impact on the basis of investigations, was significantly higher in the group undergone imaging, despite 7 out of 8 individuals found to have normal imaging results. The median total cost in true hyperprolactinemic group undergone imaging was Rs. 4370 (IQR=2412.5, 22850) as compared to macroprolactinemic groups; Rs. 3,250 (IQR=2150, 4278). There was significant difference in the cost burden of both the groups (p <0.001).
High frequency of MaPRL was identified in patients with hyperprolactinemia. Screening with PEG precipitation in hyperprolactinemic sera is simple and cost-effective.
确定总催乳素升高患者中巨催乳素（MaPRL）的发生率及其临床和经济影响。
横断面研究。
2015年3月至5月，在卡拉奇阿迦汗大学医院病理与检验医学系临床化学科。
采用聚乙二醇（PEG）沉淀法对总催乳素水平高的患者进行筛查以测定MaPRL。经口头同意后，通过电话访谈收集临床病史、影像学检查结果以及进一步检查的费用。根据单体催乳素水平，PEG处理后将患者分为真性高催乳素血症和巨催乳素血症。回顾阿迦汗大学医院登记病例的病历以确诊。
确定239例患者催乳素水平高。145例（60.7%）为巨催乳素血症，94例（39.3%）为真性高催乳素血症。真性高催乳素血症女性中溢乳明显更多（p=0.022），其次是视觉障碍（p=0.01）和头痛（p=0.006）。此外，由于大多数人群为女性，与真性高催乳素血症组相比，巨催乳素血症组的临床特征大多与非垂体原因有关，如药物摄入[42.5%（54例）对37%（30例）]、甲状腺疾病导致的不耐热[41.7%（53例）对38.3%（31例）]以及女性手术[26.8%（34例）对22.2%（18例）]。35例（37.2%）真性高催乳素血症患者进行了进一步的影像学检查（MRI、CT）。其中21例（60%）确诊为垂体腺瘤。8例MaPRL患者中，仅1例经影像学检查发现垂体微腺瘤。尽管8例中有7例影像学结果正常，但进行影像学检查组的调查总成本影响显著更高。真性高催乳素血症组进行影像学检查的总费用中位数为4370卢比（四分位间距=2412.5，22850），而巨催乳素血症组为3250卢比（四分位间距=2150，4278）。两组的费用负担存在显著差异（p<0.001）。
高催乳素血症患者中MaPRL发生率高。用PEG沉淀法筛查高催乳素血症血清简单且具有成本效益。
