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Corticotropin hormone assay interference: A case series.

D M Donegan¹, A Algeciras-Schimnich², O Hamidi³

¹Division of Endocrinology Diabetes and Metabolism, Indiana University, Indianapolis, IN, United States; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States.

Clinical Biochemistry

|November 14, 2018

Summary

Assay interference can cause falsely high adrenocorticotropic hormone (ACTH) levels in hypercortisolemia testing. This case series highlights how recognizing clinical discrepancies aids in identifying and correcting these erroneous results.

Keywords:

Assay interference Corticotropin Heterophile antibodies

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Area of Science:

Clinical Chemistry
Endocrinology
Laboratory Medicine

Background:

Plasma adrenocorticotropic hormone (ACTH) measurement is crucial for diagnosing hypercortisolemia.
Immunoassay interference can lead to inaccurate ACTH results, impacting patient management.
Falsely elevated ACTH levels may prompt unnecessary investigations for conditions like Cushing's syndrome.

Observation:

A case series of 12 patients with hypercortisolemia showed discrepancies between clinical presentation and biochemical testing.
The Siemens Immulite ACTH assay demonstrated interference, yielding falsely elevated ACTH concentrations.
These erroneous results led to further unnecessary diagnostic procedures.

Findings:

Assay interference was identified as the cause of falsely elevated ACTH levels in the studied patients.
Diagnostic strategies including sample dilution, blocking antibodies, and alternative platforms were effective in identifying interference.
Close communication between clinicians and laboratories is vital for accurate diagnosis.

Implications:

Recognizing clinically discordant biochemical results is essential for proper patient assessment.
Accurate ACTH measurement is critical to avoid misdiagnosis and inappropriate treatment for hypercortisolemia.
Implementing robust methods to detect and mitigate immunoassay interference improves diagnostic reliability.