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Elevated estradiol in a prepubertal female: within-laboratory systematic and practical interference screening.

Esra Yıldırım Demirçin1, Sevilay Sezer1, Gönül Büyükyılmaz2

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Scandinavian Journal of Clinical and Laboratory Investigation
|January 23, 2025
PubMed
Summary

Estradiol immunoassay interference can lead to misdiagnosis. Liquid chromatography-mass spectrometry (LC-MS/MS) offers a more accurate method for measuring estradiol, crucial for preventing inappropriate treatments, especially in pediatric cases.

Keywords:
EstradiolLiquid Chromatography-Mass Spectrometryendocrinologyprecocious pubertyımmunoassay

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Area of Science:

  • Clinical Chemistry
  • Analytical Biochemistry
  • Laboratory Medicine

Background:

  • Analytical errors in immunoassays can stem from interfering substances.
  • Such interferences may lead to unnecessary medical investigations and patient anxiety.
  • Estradiol measurement is particularly susceptible to interference on immunoassay platforms.

Purpose of the Study:

  • To systematically screen for estradiol interference using a practical algorithm.
  • To compare the performance of different immunoassay platforms and LC-MS/MS for estradiol measurement.
  • To evaluate the impact of specific interference mitigation techniques.

Main Methods:

  • Method comparison involving three immunoassay platforms and one LC-MS/MS.
  • Serial dilution tests to assess linearity.
  • Polyethylene glycol (PEG) precipitation to identify interference.
  • Heterophile antibody blocking tube assay.

Main Results:

  • Deviation from linearity observed during serial dilution tests.
  • Polyethylene glycol (PEG) precipitation yielded a recovery rate of 63%.
  • Significant discrepancies in patient estradiol values across different immunoassay platforms (e.g., Siemens: 389.02 pmol/L vs. Abbott: <36.7 pmol/L).
  • LC-MS/MS provided a substantially lower and potentially more accurate estradiol value (3.33 pmol/L).

Conclusions:

  • Immunoassays are prone to interferences, potentially causing overestimated estradiol results due to cross-reactivity.
  • Liquid chromatography-mass spectrometry (LC-MS/MS) demonstrates greater suitability for accurate estradiol quantification.
  • LC-MS/MS can aid in preventing misdiagnosis and inappropriate treatments, particularly in pediatric patients.