Service de Biochimie et biologie moléculaire, Hospices Civils de Lyon, LBMMS, F-69677, Hormonologie, Bron cedex, France.
Neuroscience Research Center (CRNL), Inserm UMRS 1028, Université de Lyon, Waking team, 69500, Bron, France.
Pituitary. 2022 Aug;25(4):653-657. doi: 10.1007/s11102-022-01246-8. Epub 2022 Jul 6.
Measurement of prolactin in clinical laboratories is an important component in the management of patients with pituitary adenoma. Prolactin measurement is known to be sensitive to the high-dose hook effect, in the presence of extremely high prolactin concentrations. This interference is referred to in most recent articles discussing prolactin assays and the management of prolactin-secreting pituitary adenomas. The objective of our study was to evaluate if the high-dose hook effect remains relevant in current practice, when using currently available assays.
Serum from a patient with a giant macroprolactinoma was assayed using all of the available prolactin assays in France in 2020, using native serum and after dilution. Technical inserts from assays were reviewed to assess the information on analytical principles, numbers of steps, and any reference to high dose hook effect.
Fourteen assay kits were studied by 16 laboratories; all were two-site immunometric assays, mostly using one step (11/14). Results obtained after dilution varied from 17,900 µg/L to 86,900 µg/L depending on the assay used. One tested assay was sensitive to the high-dose hook effect leading to a falsely lower prolactin concentration when measuring native serum (150 µg/L compared to 17,900 µg/L after dilution).
The high-dose hook effect still exists in a very small minority of prolactin assays. The evolution of assay methods may lead to new assays that remain sensitive to this effect in the future. We therefore advise that the hook effect should still be mentioned in prolactin assay recommendations.
在垂体腺瘤患者的管理中，临床实验室中催乳素的测量是一个重要组成部分。众所周知，在存在极高催乳素浓度的情况下，催乳素测量对高剂量钩状效应敏感。在最近讨论催乳素测定和催乳素分泌性垂体腺瘤管理的大多数文章中都提到了这种干扰。我们研究的目的是评估在当前使用的测定方法中，当前是否仍然存在高剂量钩状效应。
使用法国 2020 年所有可用的催乳素测定方法，对一位患有巨大泌乳素瘤的患者的血清进行检测，使用原始血清和稀释血清。对测定的技术插入物进行了审查，以评估分析原理、步骤数量以及任何关于高剂量钩状效应的信息。
16 个实验室研究了 14 种试剂盒；所有试剂盒均为双位点免疫测定法，大多使用一步法（11/14）。根据使用的测定方法，稀释后获得的结果从 17900μg/L 到 86900μg/L 不等。一种经过测试的测定方法对高剂量钩状效应敏感，导致测量原始血清时催乳素浓度假性降低（150μg/L 与稀释后 17900μg/L 相比）。
高剂量钩状效应仍然存在于极少数催乳素测定中。测定方法的演变可能导致未来仍对这种效应敏感的新测定方法。因此，我们建议在催乳素测定建议中仍应提及钩状效应。
