Asymptomatic elevated parathyroid hormone level due to immunoassay interference.

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Abstrakt

Tytuł:: Asymptomatic elevated parathyroid hormone level due to immunoassay interference.
Autorzy:: Zanchetta MB; IDIM, Universidad del Salvador, Libertad 836, C1012 AAR, Buenos Aires, Argentina. .
Giacoia E; IDIM, Universidad del Salvador, Libertad 836, C1012 AAR, Buenos Aires, Argentina.
Jerkovich F; IDIM, Universidad del Salvador, Libertad 836, C1012 AAR, Buenos Aires, Argentina.
Fradinger E; IDIM, Universidad del Salvador, Libertad 836, C1012 AAR, Buenos Aires, Argentina.
Źródło:: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2021 Oct; Vol. 32 (10), pp. 2111-2114. Date of Electronic Publication: 2021 Apr 24.
Typ publikacji:: Case Reports; Journal Article
Język:: English
Imprint Name(s):: Original Publication: London, UK : Springer International, c1990-
MeSH Terms:: Parathyroid Hormone*
Vitamin D*
Female ; Humans ; Immunoassay ; Middle Aged ; Reference Values ; Vitamins
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Levin O, Morris LF, Wah DT, Butch AW, Yeh MW (2011) Falsely elevated plasma parathyroid hormone level mimicking tertiary hyperparathyroidism. Endocr Pract 17:e8–e11. (PMID: 10.4158/EP10235.CR)
van der Doelen RHA, Nijhuis P, van der Velde R, Janssen MJW (2018) Normocalcemia but still elevated parathyroid hormone levels after parathyroidectomy. Clin Case Rep 6:1577–1581. (PMID: 10.1002/ccr3.1664)
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Cavalier E, Carlisi A, Chapelle JP, Delanaye P (2008) False positive PTH results: an easy strategy to test and detect analytical interferences in routine practice. Clin Chim Acta 387:150–152. (PMID: 10.1016/j.cca.2007.08.019)
Jones AM, Honour JW (2006) Unusual results from immunoassays and the role of the clinical endocrinologist. Clin Endocrinol 64:234–244. (PMID: 10.1111/j.1365-2265.2006.02439.x)
Sturgeon CM, Sprague S, Almond A, Cavalier E, Fraser WD, Algeciras-Schimnich A, Singh R, Souberbielle JC, Vesper HW, IFCC Working Group for PTH (2017) Perspective and priorities for improvement of parathyroid hormone (PTH) measurement: a view from the IFCC Working Group for PTH. Clin Chim Acta 467:42–47. (PMID: 10.1016/j.cca.2016.10.016)
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis [published correction appears in Osteoporos Int. 2015 Jul;26(7):2045-7]. Osteoporos Int 25:2359–2381. (PMID: 10.1007/s00198-014-2794-2)
Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, Dempster D, Lewiecki EM, Liu JM, Minisola S, Rejnmark L, Silva BC, Walker MD, Bilezikian JP (2014) Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99:3580–3594. (PMID: 10.1210/jc.2014-1415)
Bilezikian JP, Silverberg SJ (2010) Normocalcemic primary hyperparathyroidism. Arq Bras Endocrinol Metabol 54:106–109. (PMID: 10.1590/S0004-27302010000200004)
Contributed Indexing:: Keywords: Heterophile antibodies; Immunoassays; Parathyroid hormone; Polyethylene glycol precipitation test
Substance Nomenclature:: 0 (Parathyroid Hormone)
0 (Vitamins)
1406-16-2 (Vitamin D)
Entry Date(s):: Date Created: 20210424 Date Completed: 20211014 Latest Revision: 20211014
Update Code:: 20240104
DOI:: 10.1007/s00198-021-05950-2
PMID:: 33893820
: Czasopismo naukowe

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Background: Parathyroid hormone (PTH) measurement using immunoassays is inherently vulnerable to interferences due to the presence of different proteins such as heterophile antibodies, human anti-animal antibodies, auto-analyte antibodies, the rheumatoid factor, and others. The frequency of immunoassay interference can be as high as 6%. We report the case of a patient showing persistent high levels of PTH without impact on calcium and bone metabolism.
Case Presentation: The patient was a 59-year-old asymptomatic woman who consistently showed elevated PTH levels (385-482 pg/ml) using the Roche Elecsys (Cobas e-411) and ADVIA Centaur assays, with normal calcium, phosphorus, vitamin D, and renal function parameters. She had no history of fractures, nephrolithiasis, gastrointestinal complaints, renal insufficiency, or autoimmune diseases. Her physical examination revealed no abnormalities. Biomarkers of bone metabolism were within the reference range. To rule out falsely elevated PTH levels, we initially performed serial dilutions using both assays, which revealed nonlinearity. After a polyethylene glycol precipitation test, less than 10% of PTH was recovered from the supernatant. These results suggested the presence of heterophile antibodies as the cause of the falsely elevated PTH levels.
Conclusion: Physicians should be aware of this issue in order to avoid unnecessary clinical investigations and inappropriate treatments.
(© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.)

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