PTH immunoassay interference: differential diagnosis with normocalcemic primary hyperparathyroidism?

IF 1.6 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
Archives of Endocrinology Metabolism Pub Date : 2024-11-06 eCollection Date: 2024-01-01 DOI:10.20945/2359-4292-2023-0315
Monique Nakayama Ohe, Roberto Massao Takimoto, Claudia M Aparecida de Francischi Ferrer, Jose Viana Lima, Rosa Paula Biscolla, José Gilberto Henriques Vieira, Maria Izabel Chiamolera
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Abstract

The main diagnostic dilemma in normocalcemic hyperparathyroidism is differentiating this condition from secondary hyperparathyroidism and other causes of elevated parathyroid hormone (PTH) levels in eucalcemic patients, including potential assay interferences. Despite the analytical sensitivity of immunoassays, they may lack adequate accuracy due to several analytical interferences, such as the presence of heterophilic antibodies. Immunoassays for PTH measurement use the immunometric "sandwich" technique, and only a few cases of interference with this assay have been reported to date. We describe herein two patients in whom PTH immunoassay interference was demonstrated. Both patients presented high serum PTH levels, measured using a second-generation Roche electrochemiluminescence assay (ECLIA; Elecsys Roche, Germany), and normocalcemia. When immunoassay interference was suspected, PTH measurements were repeated using a different analytical platform, the 1-84 PTH third-generation Roche Elecsys ECLIA, resulting in normal levels. We subsequently performed serial dilutions using normal mouse serum with the second-generation ECLIA and found no linearity, indicating the presence of interference in both patients. Immunoassay interference may lead to misinterpretation of a patient's results by the laboratory and incorrect treatment planning by the attending physician. Despite its rarity, the presence of interferences in the PTH immunoassay resulting in falsely high PTH levels should be considered when the laboratory result does not match the patient's clinical presentation, thus preventing erroneous diagnoses and unnecessary therapeutic procedures.

PTH 免疫测定干扰:与正常钙血症原发性甲状旁腺功能亢进症的鉴别诊断?
正常钙血症甲状旁腺功能亢进症的主要诊断难题是如何将这种疾病与继发性甲状旁腺功能亢进症以及引起血钙患者甲状旁腺激素(PTH)水平升高的其他原因(包括潜在的检测干扰)区分开来。尽管免疫测定具有分析灵敏度,但由于存在嗜异性抗体等多种分析干扰,其准确性可能不足。测量 PTH 的免疫测定采用免疫测定 "夹心 "技术,迄今为止只有少数几个干扰该测定的病例。我们在此描述了两名PTH免疫测定受到干扰的患者。这两名患者的血清 PTH 水平都很高,使用的是第二代罗氏电化学发光检测法(ECLIA;Elecsys Roche,德国),且血钙正常。当怀疑免疫测定干扰时,使用不同的分析平台(1-84 PTH 第三代罗氏 Elecsys ECLIA)重复测量 PTH,结果显示水平正常。随后,我们使用第二代 ECLIA 对正常小鼠血清进行了序列稀释,发现没有线性关系,这表明两名患者都存在干扰。免疫测定干扰可能会导致实验室对患者结果的误解和主治医生错误的治疗计划。尽管 PTH 免疫测定中存在干扰导致 PTH 水平虚高的情况很少见,但当实验室结果与患者的临床表现不符时,仍应考虑到这一点,从而避免错误诊断和不必要的治疗过程。
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来源期刊
Archives of Endocrinology Metabolism
Archives of Endocrinology Metabolism Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
2.90
自引率
5.90%
发文量
107
审稿时长
7 weeks
期刊介绍: The Archives of Endocrinology and Metabolism - AE&M – is the official journal of the Brazilian Society of Endocrinology and Metabolism - SBEM, which is affiliated with the Brazilian Medical Association. Edited since 1951, the AE&M aims at publishing articles on scientific themes in the basic translational and clinical area of Endocrinology and Metabolism. The printed version AE&M is published in 6 issues/year. The full electronic issue is open access in the SciELO - Scientific Electronic Library Online e at the AE&M site: www.aem-sbem.com. From volume 59 on, the name was changed to Archives of Endocrinology and Metabolism, and it became mandatory for manuscripts to be submitted in English for the online issue. However, for the printed issue it is still optional for the articles to be sent in English or Portuguese. The journal is published six times a year, with one issue every two months.
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