Endocrinology and Metabolism

Case Report

Normal Repetitive Pregnancies and Tumor Regression Induced by Low-Dose Bromocriptine in a Patient with Macroprolactinoma.: Hye Jung Choi, Jin Yong Park, Woo Seok Choi, Jong Gyu Song, Hee Young Kim, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi; J Korean Endocr Soc. 2009;24(1):42-46. Published online March 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.1.42

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Abstract PDF: Prolactin-secreting adenomas are the most common pituitary tumors. Menstrual disturbances and infertility are the main complaints in women with prolactinoma. Dopaminergic agonists such as bromocriptine are well-established treatments for prolactinoma when pregnancy is desired. Pregnancy-related outcomes in macroprolactinoma are worse than those in microprolactinoma. In addition, symptomatic tumor expansion during pregnancy occurs in 30% of women with macroprolactinoma. Therefore, when women with macroprolactinoma are planning a pregnancy, serum prolactin level should be normalized and the tumor volume significantly reduced. On the other hand, a spontaneous regression of macroprolactinoma can occur after pregnancy. We report a case of macroprolactinoma showing significant tumor regression during repeated pregnancies and low dose bromocriptine treatment, with a literature review.

Original Article

High-Dose Hook Effect in Patients with Macroprolactinoma.: Sung Yeon Kim, Chul Gu Park, Young Ju Choi, Eui Sil Hong, Sang Wan Kim, Chan Soo Shin, Hak Chul Jang, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 2005;20(2):148-153. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.148

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Abstract PDF

BACKGROUND
Large amounts of antigen may produce false low values on immunoradiometric assays due to the so-called high-dose hook effect. The physicians' awareness of the possibility of the "high-dose hook effect" will prevent preoperative misdiagnosis. The study was designed to identify the frequency and clinical features of patients with pituitary macroadenomas in whom a high-dose PRL hook effect was documented. METHODS: Our retrospective study involved 42 patients with non-functioning pituitary adenomas (tumor diameter >30mm) who underwent transsphenoidal microsurgery from between Jan 1999 to Aug 2004, and 6 patients with non-functioning pituitary adenoma(tumor diameter>30mm) were selected for prospective study from Sep 2003 to Feb 2004. Our retrospective study also involved 13 patients with macroprolactinoma for the comparison of the clinical features. RESULTS: 1) The presence of a high-dose hook effect was retrospectively suggested when the PRL levels increased in 4 out of the 42 patients with non- functioning adenomas(tumor diameter >30mm) after surgery. Post-operative immunohistochemical staining of their pituitary specimens revealed the tumors to be prolactinoma. 2) Prospectively, dilution testing of the specimens obtained before surgery was done in the 6 patients, and one patient presented with a case of the hook effect. The patient's prolactin level was measured at 53.1ng/mL before dilution and this was increased up to 22,600ng/mL upon the 1:1000 dilution. 3) Conclusively, the hook effect was seen in 5 of the 48 patients(10.4%) with non-functioning pituitary adenoma(tumor diameter >30mm) 4) Compared with other 2 patient groups(the macroprolactinoma(N=13) group, and the non-functioning pituitary tumor(N=43) group), the high-dose PRL hook effect is more likely to be observed in male patients with large pituitary tumors. CONCLUSION: In order to avoid the high-dose hook effect, PRL should be assayed at 1:100~1:200 or even higher dilutions of serum from all patients(and especially the male patients) with large pituitary tumors

Citations

Citations to this article as recorded by

Multiple Endocrine Neoplasia Type 1 Presenting with an Invasive Giant Prolactinoma
Jinhoon Cha, Jin Seo Kim, Jung Suk Han, Yeon Won Park, Min Joo Kim, Yun Hyi Ku, Hong Il Kim
The Korean Journal of Medicine.2016; 91(3): 300. CrossRef

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