Detecting the interferences in adrenocorticotropic hormone measurement - three cases reinforcing the efficiency of the complementary clinical and laboratory audit.

Autor: Barlas T; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey., Yalcin MM; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey., Osmanov Z; Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey., Gulbahar O; Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey., Altinova AE; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey., Akturk M; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey., Karakoc MA; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey., Yetkin I; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey., Toruner FB; Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey.
Jazyk: angličtina
Zdroj: Biochemia medica [Biochem Med (Zagreb)] 2024 Feb 15; Vol. 34 (1), pp. 010802. Date of Electronic Publication: 2023 Dec 15.
DOI: 10.11613/BM.2024.010802
Abstrakt: 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.
Competing Interests: Potential conflict of interest None declared.
(Croatian Society of Medical Biochemistry and Laboratory Medicine.)
Databáze: MEDLINE
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