ArticlePituitary2022
Prolactin immunoassay: does the high-dose hook effect still exist?
Article in Pituitary, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- The hook effect in macroprolactinomas: tumor size thresholds, prolactin patterns, and clinical consequences - a systematic review.Pituitary · 2026Pooled it
- How to Define Success in Prolactinoma Treatment-A Systematic Review and Theoretical Framework.The Journal of clinical endocrinology and metabolism · 2026Pooled it
- Prolactinoma assessment and management: an international multidisciplinary cross-sectional survey of current practice.Pituitary · 2026Article
- Disentangling secretory ambiguity and the limitations of classical thresholds in defining prolactinomas.Pituitary · 2026Article
- Chinese consensus on the diagnosis and treatment of prolactinomas (2025 edition).Chinese neurosurgical journal · 2026Review
- Comment on "Unmasking the phospholipid-induced 'hook effect' and its implications-increasing phospholipid can also lead to a longer clotting time in coagulation assays".Journal of thrombosis and thrombolysis · 2026Article
- Hyperprolactinemia in Older Adults: A Narrative Review of Distinct Clinical Challenges and Management Strategies.Cureus · 2026Review
- High-dose Hook Effect in a Case of Giant Prolactinoma Confounded by Acute Kidney Injury.JCEM case reports · 2025Article
- A new and useful tool for differentiating prolactinomas from non-functioning pituitary adenomas: a pilot study of the cabergoline disconnection test.Einstein (Sao Paulo, Brazil) · 2025Article
- Combating Prozone Effects and Predicting the Dynamic Range of Naked-Eye Nanoplasmonic Biosensors through Capture Bioentity Optimization.ACS measurement science au · 2024Article
- Increase in Testosterone Levels and Improvement of Clinical Symptoms in Eugonadic men With a Prolactin-secreting Adenoma.Journal of the Endocrine Society · 2024Article
- Special Considerations in Pediatric Endoscopic Skull Base Surgery.Journal of clinical medicine · 2024Review
- Quasi-spherical silver nanoparticles for human prolactin detection by surface-enhanced Raman spectroscopy.RSC advances · 2024Article
- Usefulness of prolactin levels in predicting the etiology of hyperprolactinemia in a cohort of 770 patients.Archives of endocrinology and metabolism · 2024Article
- Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment.Frontiers in endocrinology · 2024Review
- Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement.Nature reviews. Endocrinology · 2023Review
- The Hook Effect: A Case Study of a Giant Invasive Prolactinoma With Falsely Low Serum Prolactin.Cureus · 2023Article
- Approach to the Patient With Prolactinoma.The Journal of clinical endocrinology and metabolism · 2023Review
- A giant invasive macroprolactinoma with recurrent nasal bleeding as the first clinical presentation: case report and review of literature.BMC endocrine disorders · 2023Review
- Surgical Management of Giant Prolactinomas: A Descriptive Study.International journal of endocrinology · 2023Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMeasurement of prolactin in clinical laboratories is an important component in the management of patients with pituitary adenoma. Prolactin measurement is known to be sensitive to the high-dose hook effect, in the presence of extremely high prolactin concentrations. This interference is referred to in most recent articles discussing prolactin assays and the management of prolactin-secreting pituitary adenomas. The objective of our study was to evaluate if the high-dose hook effect remains relevant in current practice, when using currently available assays.
methodsSerum from a patient with a giant macroprolactinoma was assayed using all of the available prolactin assays in France in 2020, using native serum and after dilution. Technical inserts from assays were reviewed to assess the information on analytical principles, numbers of steps, and any reference to high dose hook effect.
resultsFourteen assay kits were studied by 16 laboratories; all were two-site immunometric assays, mostly using one step (11/14). Results obtained after dilution varied from 17,900 µg/L to 86,900 µg/L depending on the assay used. One tested assay was sensitive to the high-dose hook effect leading to a falsely lower prolactin concentration when measuring native serum (150 µg/L compared to 17,900 µg/L after dilution).
conclusionThe high-dose hook effect still exists in a very small minority of prolactin assays. The evolution of assay methods may lead to new assays that remain sensitive to this effect in the future. We therefore advise that the hook effect should still be mentioned in prolactin assay recommendations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.