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Suspected Testosterone-Producing Tumor in a Patient Taking Biotin Supplements
Heather M Stieglitz1, Nichole Korpi-Steiner1, Brooke Katzman2
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
Journal of the Endocrine Society
|June 27, 2018
Summary
High-dose biotin supplements can interfere with common laboratory tests, causing falsely abnormal hormone levels. This vitamin interference can lead to unnecessary medical evaluations and distress for patients.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Laboratory Medicine
Background:
- Biotin (vitamin B7) is an essential cofactor for metabolic processes.
- High-dose biotin is prevalent in over-the-counter supplements for hair, skin, and nail health.
- Biotin interference with immunoassays is a known but often under-recognized issue.
Observation:
- A perimenopausal woman presented with symptoms and laboratory results suggestive of endocrine dysfunction.
- Hormonal profile showed pituitary hormones below normal and gonadal/adrenal hormones above normal.
- Comprehensive workup revealed biotin interference as the cause of abnormal laboratory findings.
Findings:
- Biotin interference can cause falsely high results in competitive immunoassays (e.g., cortisol, testosterone).
- Biotin interference can cause falsely low results in immunometric 'sandwich' immunoassays (e.g., TSH).
- Interference effects can persist for weeks after biotin discontinuation and affect multiple hormone assays.
Implications:
- Biotin interference can lead to misdiagnosis, unnecessary referrals, and diagnostic procedures.
- Patient distress and psychological burden can result from erroneous laboratory results.
- Enhanced communication among patients, clinicians, and laboratories is crucial to mitigate biotin interference.
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