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Endocrinology
Immunoassay interferences: laboratory pitfall in the diagnosis of adrenocortical carcinoma
  1. Mafalda Martins Ferreira,
  2. Carolina Moreno,
  3. Patrícia Oliveira and
  4. Isabel Paiva
  1. Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  1. Correspondence to Dr Mafalda Martins Ferreira; mafalda.ferreira{at}campus.ul.pt

Abstract

A woman in her late 50s with recent onset of hypertension, diabetes, lumbar pain and unintentional weight loss was diagnosed with a cortisol and androgen-producing adrenal mass. Despite this, serum adrenocorticotropic hormone (ACTH) concentration was inappropriately elevated, which was investigated thoroughly. Investigations included a brain magnetic resonance imaging to exclude concomitant pituitary adenoma, a corticotropin-releasing hormone stimulation test and a gallium-68 DOTATATE and 18F-FDOPA PET scan, both excluding ectopic ACTH production. Considering the disparity between clinical presentation and biochemical results, the ACTH was reanalysed using the Cobas immunoassay (Roche, Switzerland), ultimately unveiling the cause for ACTH elevation. ACTH levels had previously been measured with ACTH Immulite (Siemens, Germany), a two-site immunoassay which is prone to interferences causing falsely elevated ACTH concentrations. Inaccurate laboratory levels can lead to diagnosis delay and unnecessary diagnostic procedures and a close communication between the physicians and laboratorians is of utmost importance.

  • Adrenal disorders
  • Medical education
  • Endocrine cancer
  • Surgical oncology

https://doi.org/10.1136/bcr-2023-257320

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MMF, CM, PO and IP. The following authors gave final approval of the manuscript: MMF, CM, PO and IP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.