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Plasma poltergeists: a negative cortisol interference leading to a false diagnosis of adrenal insufficiency
Damon A Bell1, Chris M Florkowski, John G Lewis
1Department of Biochemistry, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand. Damon.Bell@health.wa.gov.au
Introduction:
Adrenal insufficiency is a rare life threatening condition with non-specific clinical signs and symptoms. This necessitates a high level of reliance on laboratory results for making the diagnosis.
Methods:
We report a case involving an interference in cortisol measurement leading to spuriously low-cortisol measurements and the incorrect diagnosis and treatment of adrenal insufficiency. We also discuss the testing used to confirm the presence and nature of the interferent.
Results:
Interference with an IgG antibody was demonstrated, and the patient was found to have a normally functioning adrenal axis.
Conclusion:
Interference in immunoassay is well described but often difficult to detect in clinical practice. Negative interference in cortisol measurement can occur and may lead to inappropriate diagnosis and treatment.
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