Makroprolaktinämie

Makroprolaktinämie is a condition characterized by elevated levels of prolactin in the blood, but with a specific characteristic. Unlike true hyperprolactinemia, in makroprolaktinämie, the majority of the elevated prolactin exists in a larger, less biologically active form. This larger form, often referred to as macroprolactin, is believed to be a complex of prolactin with antibodies, typically IgG.

The clinical significance of makroprolaktinämie is generally considered to be low. Most individuals with this condition are asymptomatic, meaning they do not experience the symptoms typically associated with true hyperprolactinemia. These symptoms can include menstrual irregularities, infertility, galactorrhea (inappropriate milk production), and decreased libido in both men and women.

Diagnosis of makroprolaktinämie is made when standard prolactin assays show elevated levels, but subsequent testing using techniques that specifically precipitate or separate the larger prolactin forms reveals that only a small fraction is the monomeric, biologically active form. This differentiation is crucial to avoid unnecessary investigations and treatments for a condition that often requires no intervention.

Management of makroprolaktinämie is typically expectant, as the condition usually does not cause health problems. If symptoms suggestive of hyperprolactinemia are present, and makroprolaktinämie is confirmed, it is important to rule out other potential causes of the symptoms. In rare instances where the symptoms are directly attributable to the small amount of biologically active prolactin, treatment options similar to those for true hyperprolactinemia, such as dopamine agonists, might be considered, though this is not the usual approach.