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Prolactin circulates predominantly as a 23 kDa monomer, and a high molecular weight form largely consisting of a complex of prolactin and anti-prolactin IgG autoantibody called macroprolactin. The latter cross-reacts with conventional laboratory assays for prolactin. We here describe the use of serial macroprolactin measurement to assist in the management of a pregnant lady with pre-conception hyperprolactinaemia in whom a magnetic resonance imaging scan had not been performed. Case Report: A 24-year old lady was found to have a raised prolactin level of 2 332 mu/L (reference range: 40–530 mu/L). Prolactin was checked because of primary infertility. Macroprolactin screening was positive, accounting for 54% of measured prolactin (estimated monomeric prolactin=1 073 mu/L). As expected, measured prolactin levels rose through pregnancy to 6 975 mu/L at 20 weeks and to 8 374 mu/L at 36 weeks gestation. Adjustment for macroprolactin and big prolactin gave estimated monomeric prolactin levels of 2 370 mu/L at 16 weeks (macroprolactin/big prolactin=66%), 2 441 mu/L at 20 weeks (macroprolactin/big prolactin=65%) and 2 596 mu/L at 36 weeks (macroprolactin/big prolactin=69%). Thus, adjusted prolactin fell within the reference range for pregnancy at these points. Gel filtration chromatography was performed on the 20-week (second trimester) sample and compared with the pre-pregnancy sample. The pattern remained similar but all components were increased in the second trimester sample (including the monomeric, big prolactin and macroprolactin forms). Conclusion: In this case report, serial measurement of macroprolactin with estimation of monomeric prolactin enhanced clinical management throughout pregnancy, saving unnecessary further investigations and avoiding unnecessary distress for the patient.

Macroprolactin: the Role of Serial Measurement Throughout Pregnancy