Falsely elevated steroid hormones in a postmenopausal woman due to laboratory interference

Fabienne Langlois, Jessica Moramarco, Gang He, Bruce R. Carr

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Laboratory interference is a drawback in hormonal testing, and clinicians should have a high index of suspicion when faced with biochemical results discordant with the patient's clinical manifestations. A 62-year-old postmenopausal woman initially consulted her primary care physician for mood lability; laboratory workup showed markedly elevated levels of total serum estradiol, progesterone, testosterone, and cortisol as measured by immunoassay. Further investigation demonstrated no evidence of estrogen effect on uterus, no adrenal or adnexal mass, and no evidence of Cushing syndrome. Conventional techniques to unmask laboratory interference, such as dilution, antigen precipitation, and using a different immunoassay did not unveil a potential laboratory interference. The patient had no apparent risk factor for analytic interference, such as absent rheumatoid factor and heterophilic antibodies, but had only mild monoclonal IgG hypergammaglobulinemia. In this case, mass spectrometry unmasked the false elevation in steroid hormones. Interference of gammaglobulins or antibodies with the labeling and separation process of the assay could be the culprits. In conclusion, we report a unique case of multiple steroid hormones elevations due to laboratory interference unmasked by mass spectrometry.

Original languageEnglish (US)
Pages (from-to)1062-1066
Number of pages5
JournalJournal of the Endocrine Society
Volume1
Issue number8
DOIs
StatePublished - Aug 2017

Keywords

  • Estradiol
  • Laboratory techniques
  • Mass spectrometry
  • Steroid measurement
  • Testosterone

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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