Macroprolactinemia: new insights in hyperprolactinemia

Hypersecretion of prolactin by lactotroph cells of the anterior pituitary may lead to hyperprolactinemia in physiological, pathological and idiopathic conditions. Most patients with idiopathic hyperprolactinemia may have radiologically undetected microprolactinomas, but some may present other causes of hyperprolactinemia described as macroprolactinemia. This condition corresponds to the predominance of higher molecular mass prolactin forms (big-big prolactin, MW > 150 kDa), that have been postulated to represent prolactin monomer complexed with anti-prolactin immunoglobulins or autoantibodies. The prevalence of macroprolactinemia in hyperprolactinemic populations between 15-46% has been reported. In the pathophysiology of macroprolactinemia it seems that pituitary prolactin has antigenicity, leading to the production of anti-prolactin autoantibodies, and these antibodies reduce prolactin bioactivity and delay prolactin clearance. Antibody-bound prolactin is big enough to be confined to vascular spaces, and therefore macroprolactinemia develops due to the delayed clearance of prolactin rather than increased production. Although the clinical symptoms are less frequent in macroprolactinemic patients, they could not be differentiated from true hyperprolactinemic patients, on the basis of clinical features alone. Although gel filtration chromatography (GFC) is known to be the gold standard for detecting macroprolactin, the polyethylene glycol precipitation (PEG) method has offered a simple, cheap, and highly suitable alternative. In conclusion, macroprolactinemia can be considered a benign condition with low incidence of clinical symptoms and therefore hormonal and imaging investigations as well as medical or surgical treatment and prolonged follow-up are not necessary.     

The danger of inadequate conceptualisation in PISA for education policy

Due to the broad acceptance of the Programme for International Student Assessment (PISA) and other comparative studies as instruments of policymaking, its accuracy is essential. This article attempts to demonstrate omissions in the conceptualisation, and consequently in calculation and interpretation, of one of the central points of PISA 2006 and 2009. The authors point to the danger of such omissions for possible evidence-based education policymaking. With regard to the reproduction of social inequalities through education, we focus on variance in student performance between schools and within schools on the science scale (PISA 2006) and in the mother tongue (PISA 2009). The thesis of the PISA study is that there are countries (Finland, Iceland and Norway) where between only 14 and 29% of the average OECD variance (33%) is attributed to between-school variance – which is good – and there are countries (Germany, Bulgaria, Austria, Hungary, Belgium, Slovenia, the Netherlands, etc.), where the variance between schools is at least ‘one-and-a-half times that of the OECD’ – which is bad. For Slovenia, we demonstrate a significantly different share of variance explained by between-school variance of the same or similar cohort if we move the point of research by only nine months. Our main argument is that such a difference in the share of variance is not the result of a substantial change in the results (grooving difference in the performance) but the result of formal organisational change – the transition of the cohort to upper secondary education. The difference in calculations also radically changes policy implications, which is crucial. While PISA data suggest the necessity of policy measures to reduce between-school variance, our calculations suggest the need for reconsideration of policy measures aimed at the reduction of within-school variance, gender differences, and differences in performance between native and immigrant students.     

Manufacturing the (In)visible: Power to Communicate,Power to Silence

The paper develops the argument of two faces of censorship as a form of symbolic violence over individuals directed either inward or outward. In both instances, the resistance to disclosure and an effort to keep things hidden are normally complemented by strategic control over the process of making things visible. Silence is usually considered a sign of censorship, but in reality it can indicate not only the suppression of, but also a resistance to, communication. Despite the changes leading toward the “structural censorship” in modern complex societies, the essential questions remain: What are the strategies to confront the (hidden) forces of censorship, and how successful can they be?