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prolactin value "hook effect"
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From:
![]() ![]() MinnieChat
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Great question!
This is what I found:
The "hook effect": In patients (usally men) with very large prolactinomas, the initial prolactin level may be read erroneously as normal or only mildly elevated. In such patients, it is important to confirm that the laboratory performed multiple dilutions of the blood sample to avoid this error known as the "hook effect". When dilutions are performed on such a blood specimen, the actual prolactin level may be as high as 10,000 to 20,000 ng/ml.
http://www.pituitary.ucla.edu/Pituitary/PituitaryDis_10.html
Here is a paper that discusses too:
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Endocr Pract. 2002 Jul-Aug;8(4):296-303. |
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"Hook effect" in prolactinomas: case report and review of literature.
Frieze TW, Mong DP, Koops MK.
Endocrinology Flight, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
OBJECTIVE: To present a case of the
"hook effect" occurring in the prolactin immunoassay in a patient with giant prolactinoma and to review this phenomenon. METHODS: We describe the clinical, biochemical, radiologic, and pathologic data of a patient with a giant prolactinoma, in which dilution testing of serum prolactin levels confirmed the presence of the hook effect. We discuss the historical and mechanistic aspects of the hook effect and then review its occurrence with the prolactin assay. RESULTS: A 65-year-old man sought medical attention because of headaches, personality changes, and "bulging" eyes. Cranial magnetic resonance imaging disclosed a 10-cm-diameter, lobulated, heterogeneous, locally invasive mass in the anterior skull base and cranial fossa. Initial laboratory testing showed a prolactin level of 164.5 ng/mL (normal range, 1.6 to 18.8). The pathology specimen from his surgical debulking procedure was
consistent with prolactinoma. Retesting of the original serum prolactin sample with serial dilutions revealed a prolactin level of 26,000 ng/mL. A postoperative diluted prolactin level was 22,000 ng/mL. Both prolactin samples demonstrated the hook effect. Dopamine agonist therapy was initiated, and the prolactin level and size of the tumor decreased substantially. The hook effect most commonly occurs when excess antigen (for example, prolactin) is present during testing. Dilution testing can counteract this assay phenomenon. CONCLUSION: Clinicians should be aware of this laboratory phenomenon when evaluating large pituitary or parasellar masses. When the hook effect is suspected, dilution testing of prolactin samples may prevent incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas.
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