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Intricate diagnosis due to falsely elevated testosterone levels by immunoassay.
Benedetta Gardini1, Marta Bondanelli2, Alessio Cariani3
1Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Endocrine
|February 13, 2025
Summary
False testosterone immunoassay results can occur due to analytical interferences. Confirming high testosterone levels with liquid chromatography-tandem mass spectroscopy is crucial to prevent misdiagnosis and unnecessary treatments.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Endocrinology
Background:
- Hormone immunoassays are susceptible to analytical interferences.
- Testosterone immunoassays, though rarely affected, can yield inaccurate results.
- Discrepancies between biochemical data and clinical presentation warrant investigation into potential interferences.
Purpose of the Study:
- To highlight the significance of analytical interferences in hormone immunoassays.
- To emphasize the need to consider interferences when laboratory results contradict clinical findings.
- To report cases of diagnostic challenges arising from testosterone immunoassay interference.
Main Methods:
- Case report of three patients with insidious diagnoses due to testosterone immunoassay interference.
- Literature review on the issue of laboratory interference in testosterone testing.
Main Results:
- Falsely elevated testosterone levels were observed.
- Heterophilic antibodies were identified as the cause of interference.
- Interference led to unnecessary investigations, misdiagnosis, and inappropriate treatments.
Conclusions:
- Elevated testosterone levels from immunoassays inconsistent with clinical presentation require confirmation.
- Liquid chromatography-tandem mass spectroscopy (LC-MS/MS) is recommended for accurate testosterone measurement.
- Confirmation testing prevents escalation of complex diagnostic workups and patient care.
