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Importance of cannulated prolactin test in the definition of hyperprolactinaemia

Whyte, MB, Pramodh, S, Srikugan, L, Gilbert, JA, Miell, JP, Sherwood, RA, McGregor, AM and Aylwin, SJB (2014) Importance of cannulated prolactin test in the definition of hyperprolactinaemia Pituitary, 18. pp. 319-325.

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Abstract

Purpose Recent guidelines suggest that a single prolactin measurement is adequate to confirm hyperprolactinaemia. This may lead to unnecessary investigation of artefactual hyperprolactinaemia. Prolactin measurement drawn from an indwelling cannula after rest removes stress as a con-founding variable. The objective was to determine the frequency of true hyperprolactinaemia amongst patients referred following a single prolactin measurement. Methods A cannulated study was considered if prolactin on referral(‘ReferralProlactin’)was\5,500 mU/L(260 ng/mL) but [410 mU/L (19 ng/mL) in males or [510 mU/L (24 ng/mL) in females, irrespective of clinical context. Case-notes of 267 patients undergoing cannulated prolactin measurement over a 10-year period (2000–2010) were reviewed. Pre-existing pituitary disease, dopamine antago-nist use, and macroprolactinaemia were excluded. Morning ante-cubital vein cannulation was followed immediately by withdrawal of ‘Repeat Prolactin’ sample. After 120-min bed-rest, ‘Resting Prolactin’ was withdrawn through the cannula. Results 235 patients were included for analysis. 64 (27 %) were within normal range; following Repeat Prolactin in 41 (17 %) and Resting Prolactin in 23 (9 %) cases. Referral Prolactin was higher in patients with true hyperprolactina-emia, 1,637 ± 100 mU/L (77.2 ± 4.7 ng/mL) than with artefactualhyperprolactinaemia,1,122 ± 68 mU/L(52.9 ± 3.2 ng/mL; P\0.001) but there was substantial overlap. 21 out of 171 cases (12 %) with true hyperprolactinaemia had a macroadenoma. Presenting symptoms did not pre-dict true hyperprolactinaemia. Referral Prolactin of 2,000 mU/L (94 ng/mL) had 97 % specificity to identify true hyperprolactinaemia. Conclusions Reliance on a single, non-rested prolactin value may lead to over-diagnosis of hyperprolactinaemia. A resting sample should be considered with random values \2,000 mU/L (94 ng/mL).

Item Type: Article
Subjects : subj_Biosciences
Authors :
AuthorsEmailORCID
Whyte, MBUNSPECIFIEDUNSPECIFIED
Pramodh, SUNSPECIFIEDUNSPECIFIED
Srikugan, LUNSPECIFIEDUNSPECIFIED
Gilbert, JAUNSPECIFIEDUNSPECIFIED
Miell, JPUNSPECIFIEDUNSPECIFIED
Sherwood, RAUNSPECIFIEDUNSPECIFIED
McGregor, AMUNSPECIFIEDUNSPECIFIED
Aylwin, SJBUNSPECIFIEDUNSPECIFIED
Date : 31 May 2014
Identification Number : 10.1007/s11102-014-0576-7
Copyright Disclaimer : The final publication is available at Springer via http://dx.doi.org/[10.1007/s11102-014-0576-7
Depositing User : Symplectic Elements
Date Deposited : 19 May 2016 09:33
Last Modified : 19 May 2016 09:33
URI: http://epubs.surrey.ac.uk/id/eprint/810555

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