Author’s Response: Macroprolactinemia Revisited—A Study on 106 Patients

Thierry Brue

Department of Endocrinology, Hopital de la Timone, 13385 Marseille, Cedex 5, France

Address correspondence to: Thierry Brue, M.D., Department of Endocrinology, Hopital de la Timone, 264 rue Saint Pierre, 13385 Marseille, Cedex 5, France. E-mail: tbrue{at}ap-hm.fr.

To the editor:

Dr. Olukoga suggests that macroprolactinemia may somehow be viewed as a biological equivalent to so-called incidentalomas. Indeed, like incidentalomas, hyperprolactinemia associated with macroprolactinemia may be discovered serendipitously in healthy subjects (1) or because of symptoms that are not actually related to this abnormal finding (2). Whether, like incidentalomas, macroprolactinemia may also be a direct cause of morbidity in some patients, however, remains an open question. Indeed, galactorrhea is known to be frequently associated with normoprolactinemia, and other symptoms such as menstrual disorders or infertility possibly have several additional causes that may be unrecognized in a given patient. Resumption of fertility on dopamine agonist therapy in macroprolactinemic patients cannot be taken as definitive evidence in the absence of a controlled study. Finally, it can be argued that hyperprolactinemia-related symptoms may have been present solely because these patients were investigated in an Endocrinology Department dedicated to the management of such symptoms.

Nevertheless, we agree that persistence of some biological effects of macroprolactinemia cannot be ruled out in view of our findings. As underlined in our study, like in other reports, macroprolactinemia may also occasionally be associated with pituitary lesions. We fully agree with Dr. Olukoga’s assumption on the clinical importance of macroprolactinemia because, irrespective of its potential consequences, this condition, if overlooked, can cause diagnostic confusion and should thus necessarily be taken into account in the work-up of hyperprolactinemic patients in all specialized centers. Although no analytical method currently available is completely blind to macroprolactinemia in all patients, we do not think that so-called low-reacting assays should be of particular interest in this respect. In contrast, we consider the development of a valid screening method as a more desirable goal to achieve.

Received July 16, 2002.

References

  1. Miyai K, Ichihara K, Kondo K, Mori S 1986 Asymptomatic hyperprolactinaemia and prolactinoma in the general population-mass screening by paired assays of serum prolactin. Clin Endocrinol (Oxf) 25:549–554[Medline]
  2. Guay AT, Sabharwal P, Varma S, Malarkey WB 1996 Delayed diagnosis of psychological erectile dysfunction because of the presence of macroprolactinemia. J Clin Endocrinol Metab 81:2512–2514[Abstract]




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