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Barlas T, Yalcin MM, Osmanov Z, Gulbahar O, Altinova AE, Akturk M, Karakoc MA, Yetkin I, Toruner FB. Detecting the interferences in adrenocorticotropic hormone measurement - three cases reinforcing the efficiency of the complementary clinical and laboratory audit. Biochem Med (Zagreb) 2024; 34:010802. [PMID: 38125613 PMCID: PMC10731737 DOI: 10.11613/bm.2024.010802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023] Open
Abstract
Accurate measurement of adrenocorticotropic hormone (ACTH) is crucial in the evaluation of pituitary and adrenal disorders. Although great progress has been achieved in ACTH measurement with immunometric assays, interference may occur and adversely affect the clinical management. The report contributes to compiling the evidence on the clinical challenges with the management of the interferences in the ACTH measurement by presenting three cases: two with clinically overt hypercortisolism and discrepant ACTH concentrations within the reference interval; the third case describes the falsely elevated ACTH in a patient with secondary adrenal insufficiency. In all patients, the results obtained with the two immunometric platforms, chemiluminescence (CLIA) immunoassay (Siemens, Immulite) and electrochemiluminescence (ECLIA) immunoassay (Roche, Cobas), were discordant. Serial dilution of plasma samples revealed nonlinearity. After polyethylene glycol (PEG) precipitation recoveries were less than 22%, 26%, and 3%, respectively, supporting interference. Moreover, a decrease in ACTH concentration after incubation in a heterophile antibody-blocking tube was observed in the second case. In the first case, misinterpretation of ACTH led to inferior petrosal sinus sampling (IPSS), whereas timely detection of assay interference prevented further investigations in other cases. Increasing awareness regarding ACTH interference and comprehensive approach in evaluation could allow timely detection, helping to prevent unnecessary testing and perplexing clinical outcomes.
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Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zakir Osmanov
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ozlem Gulbahar
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Ayhan Karakoc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
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Zhao W, Duan L, Fang L, Li J, Li S, Wang L, Zhang J, Zhang W, Cao Y. Persistent increase of carbohydrate antigen 19‐9 with an unknown reason: A seven‐year follow‐up case. J Clin Lab Anal 2022; 36:e24792. [DOI: 10.1002/jcla.24792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Wei Zhao
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Lei Duan
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Long Fang
- Department of Gastroenterology China‐Japan Friendship Hospital Beijing China
| | - Jinghua Li
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Shirui Li
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Lina Wang
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Jingying Zhang
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Wan Zhang
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
| | - Yongtong Cao
- Department of Clinical Laboratory China‐Japan Friendship Hospital Beijing China
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Loane SC, Castillo DA, Peschard ALDM, Hall HR, Kortum AJ. Spurious laboratory results associated with immunoglobulin M gammopathy in a dog with multiple myeloma. J Vet Intern Med 2022; 36:2181-2186. [PMID: 36125290 DOI: 10.1111/jvim.16540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
An 11 year old female-neutered Labrador presented for facial swelling. Clinicopathological abnormalities included hyperglobulinemia, azotemia, hypercalcemia, nonregenerative anemia, thrombocytopenia, and spurious hypoglycemia. Normoglycemia was subsequently confirmed using a cage-side analyzer (AlphaTRAK, Zoetis, UK). Serum and urine protein electrophoresis documented monoclonal (immunoglobulin M) gammopathy with Bence-Jones proteinuria. Computed tomography imaging revealed a monostotic osteolytic bone-lesion, and bone marrow cytology and histopathology documented plasmacytosis with multiple myeloma oncogene 1 / interferon regulatory factor 4 positivity, consistent with multiple myeloma. Infectious disease testing initially indicated seropositivity for Leishmania, Borrelia, and Anaplasma spp.; however, Leishmania PCR (splenic and bone marrow aspirates), and paired serological titers for Borrelia and Anaplasma were negative. Consequently, initial serological results were considered to be false positive because of paraproteinemia-associated assay interference. Chemotherapy (prednisolone and melphalan combination therapy) was initiated, but the dog was euthanased 30 days later because of the development of pericardial effusion. This is a report of spurious serological (and other laboratory) results occurring secondary to monoclonal gammopathy in a dog.
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Affiliation(s)
- Samantha C Loane
- Department of Veterinary Medicine, University of Cambridge, Cambridge, Madingley Road, United Kingdom
| | - Daniel A Castillo
- Department of Veterinary Medicine, University of Cambridge, Cambridge, Madingley Road, United Kingdom
| | | | - Harriet R Hall
- Department of Veterinary Medicine, University of Cambridge, Cambridge, Madingley Road, United Kingdom
| | - Andre J Kortum
- Department of Veterinary Medicine, University of Cambridge, Cambridge, Madingley Road, United Kingdom
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Yin Y, Zhao F, Hu Y, Lu L, Qiu L. Consideration triggered by the choice of heterophilic antibody interference detection tests in measuring ACTH for a teenager boy with a rare adrenal disease. Clin Chim Acta 2021; 519:210-213. [PMID: 33991519 DOI: 10.1016/j.cca.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Plasma ACTH is an important marker for Cushing syndrome; inaccurate measurement of ACTH concentrations due to the serum heterophile antibody may mislead diagnosis by physicians. We describe the case of a teenage boy with a rare adrenal disease who presented falsely increased ACTH concentrations (20.3 pg/ml; Siemens Immulite). METHODS Low dose dexamethasone inhibition test showed no inhibition of serum cortisol. While biochemical evidence suggested ACTH-dependent Cushing, the imaging tests suggested otherwise. Hence, further tests for interference identification, including test platform replacement, sample dilution, PEG precipitation, and use of blocking antibodies, were conducted. RESULTS The measurements of the same patient sample on three different analytical platforms suggested ACTH concentrations below 5 pg/ml. Serial dilutions of serum samples revealed nonlinearity, PEG recovery resulted in ACTH concentrations dropping to < 5 pg/ml, and interferences in plasma were blocked by a heterophilic blocking reagent (21.2 vs < 5 pg/ml), suggesting that assay interference performed on Siemens Immulite led to false-positive ACTH. Finally, the boy was diagnosed with a rare type of ACTH-independent Cushing syndrome. CONCLUSIONS The inaccurate evaluation of ACTH misled the physicians, increasing treatment time and diagnostic testing. Thus, an anti-interference workflow should be established between physicians and laboratories to avoid such cases in the future.
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Affiliation(s)
- Yicong Yin
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China
| | - Fang Zhao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China
| | - Yingying Hu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China
| | - Lin Lu
- Department of Endocrinology, Key Laboratory of National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China.
| | - Ling Qiu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China.
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Molinaris V, Bianchetti MG, Milani GP, Lava SA, Bruna RD, Simonetti GD, Faré PB. Interferences in the measurement of circulating phosphate: a literature review. Clin Chem Lab Med 2020; 58:1971-1977. [DOI: 10.1515/cclm-2020-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/14/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Inorganic phosphate in blood is currently determined by the reaction with molybdate. This report aims at reviewing conditions underlying spuriously altered levels of circulating inorganic phosphate.
Content
A systematic search of the Excerpta Medica, the National Library Database and the Web of Science database was conducted without language restriction from the earliest publication date available through January 31, 2020.
Summary
For the analysis, 80 reports published in English (n = 77), French (n = 1), German (n = 1) and Spanish (n = 1) were retained. Well-documented pseudohyperphosphatemia was observed in individuals exposed to liposomal amphotericin, in patients affected by a gammopathy, in patients with hyperlipidemia and in patients with hyperbilirubinemia. An unexplained elevated inorganic phosphate level sometimes provided a clue to the diagnosis of a gammopathy. Well-documented cases of pseudohypophosphatemia were observed in patients on large amounts of intravenous mannitol. Finally, pseudohypophosphatemia was occasionally observed on treatment with liposomal amphotericin and in patients with a gammopathy.
Outlook
In order to avoid unnecessary testing and treatment, the phenomenon of spuriously altered inorganic phosphate should be recognized. An unexplained hyperphosphatemia may provide a clue to the diagnosis of a gammopathy or a severe hyperlipidemia.
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Affiliation(s)
- Valentina Molinaris
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni , Bellinzona , Switzerland
| | | | - Gregorio P. Milani
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni , Bellinzona , Switzerland
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy
- Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy
| | - Sebastiano A.G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics , Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne , 1010 Lausanne , Switzerland
| | - Roberto Della Bruna
- EOLAB, Department of Laboratory medicine, Ente Ospedaliero Cantonale , Bellinzona , Switzerland
| | - Giacomo D. Simonetti
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni , Bellinzona , Switzerland
- Università della Svizzera Italiana , Lugano , Switzerland
| | - Pietro B. Faré
- Department of Internal Medicine, Ente Ospedaliero Cantonale , Locarno , Switzerland
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Porpiglia NM, De Palo EF, Savchuk SA, Appolonova SA, Bortolotti F, Tagliaro F. A new sample treatment for asialo-Tf determination with capillary electrophoresis: an added value to the analysis of CDT. Clin Chim Acta 2018; 483:256-262. [DOI: 10.1016/j.cca.2018.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
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Platzer V, Hebraud B, Caussé E. Alternative process for quantifying Na + and K + electrolytes in plasma with high paraprotein concentration using an automated analyzer. Clin Biochem 2017; 50:544-545. [PMID: 28438460 DOI: 10.1016/j.clinbiochem.2017.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Affiliation(s)
- V Platzer
- Biochemistry Laboratory, Institut Fédératif de Biologie, CHU Purpan, TSA 40031 Toulouse, France
| | - B Hebraud
- Hematology Department, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - E Caussé
- Biochemistry Laboratory, Institut Fédératif de Biologie, CHU Purpan, TSA 40031 Toulouse, France.
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Saad M, Moussaly E, Ibrahim U, Atallah JP, Forte F, Odaimi M. Quiz Page September 2016. Am J Kidney Dis 2016; 68:A17-20. [DOI: 10.1053/j.ajkd.2016.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/20/2016] [Indexed: 11/11/2022]
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