Koniares Katherine, Benadiva Claudio, Engmann Lawrence, Nulsen John, Grow Daniel
The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut.
F S Rep. 2023 May 24;4(3):245-250. doi: 10.1016/j.xfre.2023.05.005. eCollection 2023 Sep.
Hyperprolactinemia is common among infertile patients, with up to 15%-20% of women with oligomenorrhea having hyperprolactinemia. Suppression of the hypothalamic-pituitary-gonadal axis via inhibition of pulsatile gonadotropin releasing hormone because of hyperprolactinemia is a common endocrine etiology of infertility. There are 3 forms of human prolactin (PRL): monomeric PRL, dimeric PRL, and macro-PRL. Also known as big-big PRL, macro-PRL has a molecular weight >150 kDa and normally comprises 5%-10% of circulating PRL. When the predominant form of circulating PRL is macro-PRL, macroprolactinemia is diagnosed. Among patients with hyperprolactinemia, 10%-46% have macroprolactinemia. Patients with macroprolactinemia are at risk of unnecessary pituitary imaging and treatment with dopamine agonists if not correctly diagnosed. Given the high prevalence of macroprolactinemia among patients with elevated PRL levels and the different management of patients with macroprolactinemia vs true monomeric hyperprolactinemia, all patients with persistently elevated PRL levels should be screened for macro-PRL.
高催乳素血症在不孕患者中很常见，高达15%-20%的月经过少女性患有高催乳素血症。高催乳素血症通过抑制脉冲式促性腺激素释放激素来抑制下丘脑-垂体-性腺轴，这是不孕常见的内分泌病因。人催乳素（PRL）有3种形式：单体PRL、二聚体PRL和大分子PRL。大分子PRL也称为大大PRL，分子量>150 kDa，通常占循环PRL的5%-10%。当循环PRL的主要形式是大分子PRL时，即可诊断为大分子催乳素血症。在高催乳素血症患者中，10%-46%患有大分子催乳素血症。如果未得到正确诊断，大分子催乳素血症患者有接受不必要的垂体成像检查和使用多巴胺激动剂治疗的风险。鉴于PRL水平升高的患者中大分子催乳素血症的患病率很高，且大分子催乳素血症患者与真正的单体性高催乳素血症患者的治疗方法不同，所有PRL水平持续升高的患者都应进行大分子PRL筛查。
