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Badr H, Young PE, Dong J, Okorodudu AO. Combined bisalbuminemia and Bisalbuminuria: A rare finding on serum and urine electrophoresis. Clin Chim Acta 2024; 552:117635. [PMID: 37952813 DOI: 10.1016/j.cca.2023.117635] [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: 10/09/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Bisalbuminemia and bisalbuminuria are rarely encountered serum and urine albumin anomalies characterized by the presence of a bifid albumin band on serum/urine protein electrophoresis (SPE/UPE) and serum/urine immunofixation electrophoresis (SIFE/UIFE). They are usually detected incidentally while screening for monoclonal gammopathy with a cumulative frequency of 1:1,000---1:10,000. CASE REPORT We report two cases of bisalbuminemia in two adult male diabetic patients. The first patient had a history of rheumatoid arthritis and strong clinical suspicion for Sjogren syndrome. The SPEP/UPEP and SIFE/UIFE in this patient showed combined bisalbuminemia and bisalbuminuria. While the second patient had chronic kidney disease due to nephrotic syndrome but showed bisalbuminemia alone. CONCLUSION Bisalbuminemia and bisalbuminuria are rare findings with few case reports available in the English literature. These findings may occur secondary to inherited albumin variants or may be acquired. Diabetes mellitus is the medical condition most associated with acquired bisalbuminemia and bisalbuminuria. Although most cases of bisalbuminemia and bisalbuminuria are clinically insignificant, some albumin variants may have altered affinity for steroid hormones (e.g., thyroxine) and/or drugs which potentially could be clinically significant.
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Affiliation(s)
- Heba Badr
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Paul E Young
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Jianli Dong
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Anthony O Okorodudu
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States.
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Human Serum Albumin: From Molecular Aspects to Biotechnological Applications. Int J Mol Sci 2023; 24:ijms24044081. [PMID: 36835490 PMCID: PMC9965750 DOI: 10.3390/ijms24044081] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Human serum albumin (HSA), the most abundant protein in plasma, is a monomeric multidomain macromolecule that represents the main determinant of plasma oncotic pressure and the principal modulator of fluid distribution between body compartments [...].
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Varughese MG, Deshotels MR, Zhang L, Ballantyne CM. Severe hypercholesterolemia in a patient with very low albumin and normal renal function. J Clin Lipidol 2023; 17:64-67. [PMID: 36411186 DOI: 10.1016/j.jacl.2022.10.011] [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: 06/07/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
A 20-year-old male presented with severe elevation in low-density lipoprotein cholesterol (LDL-C). Initial genetic testing for familial hypercholesterolemia was negative. Patient also had low albumin, and further genetic testing showed homozygous variants in the ALB gene, suggesting congenital analbuminemia (CAA) causing severe hyperlipidemia. CAA is an autosomal recessive disorder with incidence of about 1:1,000,000. The gene for albumin is a single autosomal gene, and pathological variants that affect splicing lead to premature stop, nonsense variants, and deletions that result in a defect in albumin synthesis with CAA. CAA can be fatal in the prenatal period and cause infections in early childhood. CAA is tolerated better in adulthood because of compensatory increase in other plasma proteins. Plasma lipoproteins also increase, and CAA can cause gross hyperlipidemia with severe elevations in LDL-C and hypercholesterolemia. Genetic examination of ALB is mandatory to establish the diagnosis. Early diagnosis may be important to initiate lipid-lowering treatments to avoid premature coronary artery disease.
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Affiliation(s)
- Mini G Varughese
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Matthew R Deshotels
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Lilei Zhang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Li B, Moore J, Potter H, du Toit S, Nirmalaraj K, Florkowski C. Two cases of discordant thyroid function tests: familial dysalbuminaemic hyperthyroxinaemia and dystransthyretinaemic hyperthyroxinaemia. Intern Med J 2023; 53:152-154. [PMID: 36693642 DOI: 10.1111/imj.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Bobby Li
- Te Whatu Ora - Health New Zealand, Wellington, New Zealand.,Specialist Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Jordyn Moore
- Te Whatu Ora - Health New Zealand, Wellington, New Zealand.,Specialist Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Howard Potter
- Te Whatu Ora - Health New Zealand, Wellington, New Zealand.,Molecular Pathology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Stephen du Toit
- Te Whatu Ora - Health New Zealand, Wellington, New Zealand.,Biochemistry, Waikato Hospital Laboratory, Hamilton, New Zealand
| | - Kingsley Nirmalaraj
- Te Whatu Ora - Health New Zealand, Wellington, New Zealand.,Department of Endocrinology, Tauranga Hospital, Tauranga, New Zealand
| | - Chris Florkowski
- Te Whatu Ora - Health New Zealand, Wellington, New Zealand.,Specialist Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand
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Narinx N, David K, Walravens J, Vermeersch P, Claessens F, Fiers T, Lapauw B, Antonio L, Vanderschueren D. Role of sex hormone-binding globulin in the free hormone hypothesis and the relevance of free testosterone in androgen physiology. Cell Mol Life Sci 2022; 79:543. [PMID: 36205798 DOI: 10.1007/s00018-022-04562-1] [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: 04/19/2022] [Revised: 08/12/2022] [Accepted: 09/17/2022] [Indexed: 11/03/2022]
Abstract
According to the free hormone hypothesis, biological activity of a certain hormone is best reflected by free rather than total hormone concentrations. A crucial element in this theory is the presence of binding proteins, which function as gatekeepers for steroid action. For testosterone, tissue exposure is governed by a delicate equilibrium between free and total testosterone which is determined through interaction with the binding proteins sex hormone-binding globulin and albumin. Ageing, genetics and various pathological conditions influence this equilibrium, hereby possibly modulating hormonal exposure to the target tissues. Despite ongoing controversy on the subject, strong evidence from recent in vitro, in vivo and human experiments emphasizes the relevance of free testosterone. Currently, however, clinical possibilities for free hormone diagnostics are limited. Direct immunoassays are inaccurate, while gold standard liquid chromatography with tandem mass spectrometry (LC-MS/MS) coupled equilibrium dialysis is not available for clinical routine. Calculation models for free testosterone, despite intrinsic limitations, provide a suitable alternative, of which the Vermeulen calculator is currently the preferred method. Calculated free testosterone is indeed associated with bone health, frailty and other clinical endpoints. Moreover, the added value of free testosterone in the clinical diagnosis of male hypogonadism is clearly evident. In suspected hypogonadal men in whom borderline low total testosterone and/or altered sex hormone-binding globulin levels are detected, the determination of free testosterone avoids under- and overdiagnosis, facilitating adequate prescription of hormonal replacement therapy. As such, free testosterone should be integrated as a standard biochemical parameter, on top of total testosterone, in the diagnostic workflow of male hypogonadism.
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Affiliation(s)
- N Narinx
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000, Leuven, Belgium.,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - K David
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - J Walravens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - P Vermeersch
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - F Claessens
- Laboratory of Molecular Endocrinology, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - T Fiers
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - L Antonio
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - D Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000, Leuven, Belgium. .,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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