Canterbury District Health Board Endocrine Test Centre Protocols. Date Signature Next review Sign when read

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1 0855 Prolactin Series test ASY-855.1: Associated documents Prolactin Series Test Patient information sheet Prolactin series sample request form 0 ASY-855.2: Distribution of Documents Copy No Number Location 1 Quality Centre Endocrine Test Centre 3 G:\Division\NDO\common\ETCProtocols\0855 Prolactin Series Test.doc ASY-855.3: Review of Document: Date Signature Next review Sign when read G:\Division\NDO\common\ETCProtocols\0855 Prolactin Series Test.doc Do not photocopy Document number: Page 1 of 6

2 Table of Contents ASY-855.1: Associated documents... 1 ASY-855.2: Distribution of Documents... 1 ASY-855.3: Review of Document:... 1 ASY-855.5: Purpose of prolactin series test... 3 ASY-855.6: Set-up checklist for prolactin series test... 3 ASY-855.7: Protocol for prolactin series test... 3 ASY : On day of test... 3 ASY-855.8: Interpretation... 4 ASY : Interpretation... 4 ASY-855.9: Medications that can elevate prolactin levels... 4 ASY : References... 5 ASY : Prolactin series sample request form... 6 Do not photocopy Document number: Page 2 of 6

3 ASY-855.5: Purpose of prolactin series test The prolactin series test helps distinguish between pathological mildly raised prolactin, from physiological or false positively raised prolactin. ASY-855.6: Set-up checklist for prolactin series test ASY : Prior to test a Ensure that Patient Information Sheet has been sent out to the patient. b To minimise frequency of a failed test due to medication use: i Check that patient medications are as per referral. ii Check for any over-the counter medications, particularly anti-emetics. iii Check whether any instructions from requesting doctor or endocrinologist regarding stopping certain medications have been followed. If patient is taking medications that might increase prolactin (such as anti-emetics, anti-pyschotics, as per table below), and you suspect the requesting doctor may not be aware of this, then consider contacting the requesting doctor prior to proceeding with the test. It is the requesting doctor s responsibility to adjust medications as they see fit, prior to the test. c Check patient is not pregnant or breast-feeding (if so, delay until no longer pregnant or breast feeding) d Arrange time and date of test preferably in the morning (when prolactin levels are lower). e Ask patient to allow up to 2 hours for the test. ASY-855.7: Protocol for prolactin series test ASY : On day of test a Patient should be fasting from midnight, and have water only from midnight. b Insert x1 intravenous cannula, and then ensure patient is resting for 20 minutes. c At 20 minutes withdraw 2ml of blood from IV line and discard, then take initial blood sample for prolactin (4ml of blood in to a red or green top tube). d Label time of collection on each sample, and complete the Prolactin Dynamic test series lab form 0) e Whilst patient is resting, take blood samples for prolactin at 40mins and 60 mins. f That is then the end of the test for most patients, although the test can run out to 2 hours if important to get best chance of excluding falsely elevated prolactin. This would usually be at the Endocrinologist s discretion but the Endocrine Test Centre Nurse may also elect to extend the test e.g. in a highly stressed patient. g Remove intravenous cannula, and patient can go home. If any medications stopped prior to the test, confirm with requesting doctor whether these should be re-started. Do not photocopy Document number: Page 3 of 6

4 ASY-855.8: Interpretation One normal prolactin level should be considered as normal, and an isolated raised one should be discarded as spurious 1. If the prolactin remains elevated at 2 hours, then the prolactin is likely to be genuinely elevated 2. Factors that can increase prolactin include non-fasting sample, stress of venepuncture, an afternoon (rather than morning) sample, exercise, recent seizure, hypothyroidism, renal failure, laboratory error or reference range issues, pregnancy, breast-feeding, chest wall trauma, medications and micro or macro prolactinomas, and lesions affecting the hypothalamus or pituitary stalk. ASY-855.9: Medications that can elevate prolactin levels Frequency of prolactin Medication class elevation Antipsychotics, first generation Chlorpromazine Fluphenazine Haloperidol Loxapine Perphenazine Pimozide Thiothixene Trifluoperazine Antipsychotics, second generation Aripiprazole None or low Asenapine Clozapine None or low Olanzapine Quetiapine None or low Risperidone Ziprasidone Antidepressants, cyclic Amitriptyline Desipramine Clomipramine Nortriptyline None Antidepressants, SSRI Citalopram, fluoxetine, paroxetine, sertraline None or low (rare reports) Antidepressants, other Bupropion, venlafaxine, mirtazapine, nefazodone, None trazodone Antiemetic and gastrointestinal Metoclopramide Domperidone Prochlorperazine Antihypertensives Verapamil Methyldopa Opioid analgesics Methadone, morphine, others Transient increase for several hours following dose Do not photocopy Document number: Page 4 of 6

5 ASY : References 1) A Majumdar and N Mangal, Hyperprolactinemia. J Hum Reprod Sci Jul-Sep; 6(3): ) R Agarwal, S Pramodh, P Durroch, S Chambers, A McGregor & SJB Aylwin. Is a repeat or resting prolactin necessary in the investigation of hyperprolactinaemia? Endocrine Abstracts (2006) 11 P200 3) Uptodate.com. Accessed 13 th February 2017 Do not photocopy Document number: Page 5 of 6

6 ASY : Prolactin series sample request form Canterbury Health Labs DYNAMIC TEST - SERIAL SAMPLE FORM Results/Copies to Dynamic Test Type Surname First names D.O.B Gneder Patient NHI Prolactin series Ward Consultant Collected by Collection Date Senders reference num ber Charge to (HIC Code) Collection Time Reference - Sequence Time 1 (20 mins) 2 (40mins) 3 (60mins) CHLabs Delphic Barcode Number Analyte(s) to be measured 1 Prolactin 2 Prolactin 3 Prolactin 4 (2 hours, if required) 4 5 Prolactin 6 7 Canterbury Health Laboratories will rely on the requestor to obtain informed consent for the requested tests, and any additional related tests, to be performed by the laboratory Do not photocopy Document number: Page 6 of 6