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Monomeric Prolactin(Active)

Reproductive
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Report in 48Hrs

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No Fasting Required

Details

Detects bioactive prolactin.

₹1,228₹1,755

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Monomeric Prolactin (Active) - Comprehensive Test Guide

  • Why is it done?
    • Measures the biologically active form of prolactin, the hormone responsible for milk production and lactation in women
    • Distinguishes between monomeric prolactin (active hormone) and prolactin aggregates (macroprolactin), which may be biologically inactive
    • Ordered to evaluate unexplained elevated prolactin levels and determine clinical significance
    • Primary indications include: investigation of galactorrhea (abnormal milk discharge), menstrual irregularities, infertility, erectile dysfunction, and suspected pituitary disorders
    • Performed to identify macroprolactinemia (elevated macroprolactin), which causes false-positive elevated prolactin results despite absence of clinical symptoms
    • Used to monitor patients with prolactinomas or other pituitary tumors undergoing treatment
    • Typically performed in early morning hours (between 8-10 AM) as prolactin levels naturally fluctuate throughout the day
  • Normal Range
    • Women (non-pregnant): 4.8-29.2 mIU/L or 0.2-0.9 ng/mL (reference ranges may vary by laboratory)
    • Men: 2.1-17.7 mIU/L or 0.1-0.5 ng/mL
    • Monomeric prolactin should typically represent >60% of total prolactin levels; values below this threshold may indicate macroprolactinemia
    • Units of measurement: mIU/L (milli-international units per liter) or ng/mL (nanograms per milliliter); conversion factor is approximately 1 ng/mL = 20 mIU/L
    • Normal results indicate biologically active prolactin is within healthy ranges and unlikely to cause pathological effects
    • Elevated monomeric prolactin (>30 ng/mL or >600 mIU/L) suggests true hyperprolactinemia requiring investigation
    • Low monomeric prolactin with high total prolactin suggests macroprolactinemia, which is often clinically insignificant
  • Interpretation
    • Elevated Monomeric Prolactin (High Results):
      • Indicates true hyperprolactinemia with biologically active elevated prolactin levels
      • Clinical significance: May explain symptoms such as galactorrhea, amenorrhea or irregular periods, infertility, decreased libido, and erectile dysfunction
      • Requires further investigation to identify underlying cause (prolactinoma, medication side effects, hypothyroidism, renal failure, pituitary stalk compression)
    • Normal Monomeric Prolactin (Normal Results):
      • Suggests active prolactin is within physiological limits; unlikely to cause clinical dysfunction
      • If total prolactin was elevated but monomeric is normal, indicates macroprolactinemia (usually benign, no treatment required)
      • Helps rule out pathological causes of hyperprolactinemia in patients with elevated total prolactin levels
    • Low Monomeric Prolactin (<5% of total):
      • Indicates significant macroprolactinemia; majority of prolactin is in biologically inactive form
      • Generally clinically benign; symptoms are typically absent despite elevated total prolactin
      • May avoid unnecessary imaging studies, medications, or surgical interventions for false-positive results
    • Factors Affecting Results:
      • Time of day: Prolactin levels naturally peak during sleep and early morning; testing should occur between 8-10 AM
      • Medications: Dopamine antagonists (antipsychotics), metoclopramide, verapamil, risperidone, haloperidol can elevate levels
      • Stress and physical activity: Acute stress, exercise, and chest wall stimulation can increase prolactin levels
      • Pregnancy and lactation: Significantly elevated monomeric prolactin levels are physiologically normal
      • Hypothyroidism and renal disease: Can elevate prolactin through altered metabolism or TRH increases
      • Pituitary stalk compression: Any mass effect can impair dopamine inhibition of prolactin secretion
  • Associated Organs
    • Primary Organ System:
      • Pituitary gland (anterior pituitary): Primary source of prolactin production; lactotroph cells directly affected by monomeric prolactin levels
      • Hypothalamus: Regulates prolactin through dopamine inhibition and TRH stimulation
      • Breast tissue: Primary target organ; monomeric prolactin stimulates milk production and lactation
      • Reproductive system (ovaries and testes): Prolactin affects GnRH secretion and reproductive hormone levels
    • Conditions Associated with Abnormal Results:
      • Prolactinoma: Prolactin-secreting pituitary adenoma; most common pathological cause of elevated monomeric prolactin
      • Acromegaly and other pituitary adenomas: May compress pituitary stalk, impacting prolactin regulation
      • Primary hypothyroidism: Elevated TRH stimulates increased prolactin secretion
      • Chronic kidney disease: Impaired renal prolactin clearance leads to accumulation
      • Polycystic ovary syndrome (PCOS): Often associated with mild prolactin elevation
      • Hypogonadism: Elevated prolactin can suppress GnRH, leading to testosterone deficiency in men and estrogen deficiency in women
      • Macroprolactinemia: Biologically inactive prolactin aggregates; generally asymptomatic and benign
    • Potential Complications of Elevated Monomeric Prolactin:
      • Infertility: Suppression of GnRH and LH/FSH leads to anovulation in women and decreased sperm production in men
      • Osteoporosis: Chronic hypogonadism from elevated prolactin increases fracture risk
      • Cardiovascular complications: Associated with metabolic dysfunction and increased cardiovascular risk
      • Mass effect symptoms (if prolactinoma): Visual field defects, headaches, hypopituitarism from large adenomas
  • Follow-up Tests
    • If Elevated Monomeric Prolactin:
      • MRI of pituitary gland: Gold standard imaging to rule out prolactinoma or other sellar masses; typically recommended for levels >200 mIU/L
      • Thyroid function tests (TSH, free T4): To exclude hypothyroidism as secondary cause
      • Comprehensive metabolic panel and renal function (creatinine, BUN): To assess for chronic kidney disease
      • Gonadotropins (LH, FSH): Assess impact on reproductive axis
      • Sex hormones: Testosterone (males), estradiol (females) to evaluate reproductive consequences
      • Pregnancy test (beta-hCG): In women of childbearing age to exclude pregnancy
      • Medication review: Assess for prolactin-raising medications; consider alternative medications if appropriate
      • Other pituitary hormones: ACTH, cortisol, GH, IGF-1 to assess overall pituitary function
    • If Macroprolactinemia Confirmed (Low Monomeric, High Total):
      • Reassurance and patient education: Macroprolactinemia is typically benign and requires no treatment
      • No imaging or hormone level monitoring typically required
      • Avoid unnecessary diagnostic workup and medications
    • If Prolactinoma Diagnosed:
      • Repeat monomeric prolactin levels: Every 2-4 weeks during initial dopamine agonist therapy, then every 3-6 months for monitoring
      • Serial MRI imaging: Follow-up MRI in 3-6 months, then annually to assess tumor size response to treatment
      • Visual field testing: If macroadenoma with mass effect on optic chiasm
      • Periodic assessment of other pituitary hormones during treatment
    • Complementary Tests:
      • Total prolactin level: Calculated and compared with monomeric prolactin to determine proportion of macroprolactin
      • Polyethylene glycol precipitation or ultrafiltration: May be ordered to clarify macroprolactinemia status
      • Bone density study (DEXA scan): In patients with chronic hyperprolactinemia and hypogonadism to assess osteoporosis risk
  • Fasting Required?
    • Answer: NO - Fasting is not required for monomeric prolactin testing; food intake does not affect prolactin levels
    • Patient Preparation Requirements:
      • Timing: Blood draw between 8-10 AM when prolactin levels are most stable; avoid evening hours due to natural circadian elevation
      • Rest period: Sit quietly for 10-15 minutes before blood draw; stress and physical activity can temporarily elevate prolactin
      • Clothing: Avoid tight-fitting bras or chest compression 30 minutes before blood draw, as chest wall stimulation increases prolactin
    • Medications to Consider:
      • DO NOT stop medications before testing: Continue all regular medications unless specifically instructed by physician
      • Medications that elevate prolactin (continue unless instructed otherwise): Antipsychotics (risperidone, haloperidol), metoclopramide, verapamil, SSRIs, opioids, estrogen, cimetidine, domperidone
      • Inform laboratory/physician of all medications: Interpretation of results requires knowledge of current medications
    • Additional Instructions:
      • Avoid strenuous exercise for 24 hours before test: Physical activity acutely increases prolactin levels
      • Minimize stress before test: Psychological stress transiently elevates prolactin; remain calm before blood draw
      • Consider repeat testing: If results are borderline or if abnormal medication effects are suspected, physician may recommend repeat testing after 2-3 days
      • Women: Test should be performed in follicular phase of menstrual cycle if possible; ensure not pregnant before test

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