RESUMO
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
Assuntos
Hiperprolactinemia , Neoplasias Hipofisárias , Humanos , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/etiologia , Laboratórios , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , ProlactinaRESUMO
Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
RESUMO
INTRODUCTION: Specific TSH and free thyroxine ranges are needed to adequately assess maternal thyroid function during pregnancy. AIM: The aim of this review is to review studies reporting data on references TSH and free thyroxine levels in Spanish women during the first trimester of pregnancy. MATERIAL AND METHODS: Literature search and selection of studies providing reference TSH ranges in the first trimester of pregnancy. RESULTS: The TSH cut-off point to define hypothyroidism (P97.5) was different depending on the immunoassay used. Gestational age, thyroid autoimmunity, and maternal iodide nutritional status can determine the variability seen in the results. CONCLUSIONS: Differences found in the studies do not allow for establishing a unified TSH reference range. However, results suggest that the TSH upper reference limit is close to 4µU/mL. Reference TSH ranges specific for each population and immunoassay during pregnancy should be defined.
Assuntos
Primeiro Trimestre da Gravidez/sangue , Tireotropina/sangue , Autoanticorpos/sangue , Feminino , Idade Gestacional , Humanos , Imunoensaio , Iodo/urina , Gravidez , Primeiro Trimestre da Gravidez/urina , Valores de Referência , Espanha , Tiroxina/sangueRESUMO
In order to determine the impact of the application of the American Thyrold Associations (ATA) criteria for the diagnosis of hypothyroidism in pregnant women in the health district of Vigo, Spain, concentrations of serum thyrotropin (TSH), free thyroxine (T4L) and anti-thyroid antibodies were analyzed, comparing the frequency of pregnant women diagnosed with hypothyroidism and applying the criteria used in the hormone laboratory at Xeral Hospital and referential criteria established by ATA. The application of ATA referential criteria increased by 29.6% the number of female patients diagnosed with hypothyroidism. The application of ATA guidelines had an impact on the measurement of TSH concentrations in pregnant women, which calls for an evaluation of referential values of TSH based on the population and the local diagnostic methods.
Assuntos
Hipotireoidismo/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Feminino , Humanos , Gravidez , Sociedades Médicas , Espanha , Estados UnidosRESUMO
Con el objetivo de determinar el impacto de la aplicación de los criterios de la Asociación Americana de Tiroides (ATA) en el diagnóstico de hipotiroidismo en gestantes del área sanitaria de Vigo en España, se analizó la concentración sérica de tirotropina (TSH), tiroxina libre (T4L) y anticuerpos antitiroideos, comparando la frecuencia de gestantes diagnosticadas de hipotiroidismo aplicando los criterios utilizados en el laboratorio de hormonas del Hospital Xeral y los criterios de referencia propuestos por la ATA. La asunción de dichos criterios implicaría un aumento de un 29,6% de pacientes diagnosticadas de hipotiroidismo. La aplicación de los criterios ATA tuvo una repercusión en la medición de la concentración de TSH en gestantes lo que sugiere una evaluación de los valores de referencia de TSH en función de la población y los métodos de diagnóstico locales.
In order to determine the impact of the application of the American Thyrold Associations (ATA) criteria for the diagnosis of hypothyroidism in pregnant women in the health district of Vigo, Spain, concentrations of serum thyrotropin (TSH), free thyroxine (T4L) and anti-thyroid antibodies were analyzed, comparing the frequency of pregnant women diagnosed with hypothyroidism and applying the criteria used in the hormone laboratory at Xeral Hospital and referential criteria established by ATA. The application of ATA referential criteria increased by 29.6% the number of female patients diagnosed with hypothyroidism. The application of ATA guidelines had an impact on the measurement of TSH concentrations in pregnant women, which calls for an evaluation of referential values of TSH based on the population and the local diagnostic methods.