Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview
Background. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and l...
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Wiley
2013-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2013/634349 |
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| author | Atanaska Elenkova Zdravka Abadzhieva Nikolai Genov Vladimir Vasilev Georgi Kirilov Sabina Zacharieva |
| author_facet | Atanaska Elenkova Zdravka Abadzhieva Nikolai Genov Vladimir Vasilev Georgi Kirilov Sabina Zacharieva |
| author_sort | Atanaska Elenkova |
| collection | DOAJ |
| description | Background. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and long-term followup in subjects with macroprolactinemia. However, there is evidence for overlapping clinical features among subjects with hyperprolactinemia due to monomeric or “big big” PRL isoform. Case Presentation. We present a 35-year-old female patient with secondary amenorrhea, mild obesity, hirsutism, headache and blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 10 610 mIU/L) almost exclusively due to macroprolactin isoform (MPRL = 10 107 mIU/L; recovery after PEG precipitation 4.7%) and hypogonadotropic hypogonadism. An invasive pituitary macroadenoma was visualized on MRI, and cabergoline therapy was initiated. Disappearance of clinical signs and symptoms, normalization of gonadotropin levels, and restoration of regular ovulatory menstrual cycles after 1 year of treatment are arguments in favor of preserved-macroprolactin bioactivity in this case. The significant decrease in MPRL levels and tumor volume in response to dopamine agonist therapy is suggestive for the tumoral origin of this isoform. Conclusions. Although macroprolactinemia is considered to be a benign condition, pituitary imaging, dopamine agonist treatment, and prolonged followup should be recommended in some particular cases. |
| format | Article |
| id | doaj-art-37ee3845c0464a2da909e2064732ebdd |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-37ee3845c0464a2da909e2064732ebdd2025-02-03T05:59:09ZengWileyCase Reports in Endocrinology2090-65012090-651X2013-01-01201310.1155/2013/634349634349Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and MinireviewAtanaska Elenkova0Zdravka Abadzhieva1Nikolai Genov2Vladimir Vasilev3Georgi Kirilov4Sabina Zacharieva5USHATE “Acad. Ivan Pentchev”, Clinical Centre of Endocrinology and Gerontology, Medical University-Sofia, 2 Zdrave Street, 1431 Sofia, BulgariaUSHATE “Acad. Ivan Pentchev”, Clinical Centre of Endocrinology and Gerontology, Medical University-Sofia, 2 Zdrave Street, 1431 Sofia, BulgariaUSHATE “Acad. Ivan Pentchev”, Clinical Centre of Endocrinology and Gerontology, Medical University-Sofia, 2 Zdrave Street, 1431 Sofia, BulgariaUSHATE “Acad. Ivan Pentchev”, Clinical Centre of Endocrinology and Gerontology, Medical University-Sofia, 2 Zdrave Street, 1431 Sofia, BulgariaUSHATE “Acad. Ivan Pentchev”, Clinical Centre of Endocrinology and Gerontology, Medical University-Sofia, 2 Zdrave Street, 1431 Sofia, BulgariaUSHATE “Acad. Ivan Pentchev”, Clinical Centre of Endocrinology and Gerontology, Medical University-Sofia, 2 Zdrave Street, 1431 Sofia, BulgariaBackground. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and long-term followup in subjects with macroprolactinemia. However, there is evidence for overlapping clinical features among subjects with hyperprolactinemia due to monomeric or “big big” PRL isoform. Case Presentation. We present a 35-year-old female patient with secondary amenorrhea, mild obesity, hirsutism, headache and blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 10 610 mIU/L) almost exclusively due to macroprolactin isoform (MPRL = 10 107 mIU/L; recovery after PEG precipitation 4.7%) and hypogonadotropic hypogonadism. An invasive pituitary macroadenoma was visualized on MRI, and cabergoline therapy was initiated. Disappearance of clinical signs and symptoms, normalization of gonadotropin levels, and restoration of regular ovulatory menstrual cycles after 1 year of treatment are arguments in favor of preserved-macroprolactin bioactivity in this case. The significant decrease in MPRL levels and tumor volume in response to dopamine agonist therapy is suggestive for the tumoral origin of this isoform. Conclusions. Although macroprolactinemia is considered to be a benign condition, pituitary imaging, dopamine agonist treatment, and prolonged followup should be recommended in some particular cases.http://dx.doi.org/10.1155/2013/634349 |
| spellingShingle | Atanaska Elenkova Zdravka Abadzhieva Nikolai Genov Vladimir Vasilev Georgi Kirilov Sabina Zacharieva Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview Case Reports in Endocrinology |
| title | Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview |
| title_full | Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview |
| title_fullStr | Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview |
| title_full_unstemmed | Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview |
| title_short | Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview |
| title_sort | macroprolactinemia in a patient with invasive macroprolactinoma a case report and minireview |
| url | http://dx.doi.org/10.1155/2013/634349 |
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