Donegan D M, Algeciras-Schimnich A, Hamidi O, Young W F, Nippoldt T, Bancos I, Erickson D
Division of Endocrinology Diabetes and Metabolism, Indiana University, Indianapolis, IN, United States; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States.
Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
Clin Biochem. 2019 Jan;63:143-147. doi: 10.1016/j.clinbiochem.2018.11.006. Epub 2018 Nov 10.
Measuring the plasma corticotropin (ACTH) concentration is an important step in determining the underlying cause in patients with hypercortisolemia. Interfering substances in immunoassays can lead to erroneous results impacting clinical management. We describe a case series of 12 patients, the majority of whom were being investigated for possible Cushing's syndrome and in whom inconsistencies between the clinical picture and biochemical testing raised concerns of assay interference. ACTH assay interference resulted in falsely elevated ACTH concentrations using the Siemens Immulite assay and consequently led to additional unnecessary testing. Communication between physician and laboratory as well as appropriate investigation (including sample dilution, use of blocking antibodies and testing on an alternate platform) resulted in assay interference identification. Recognition of biochemical results which are clinically discrepant remains an essential step in patient assessment.
测量血浆促肾上腺皮质激素（ACTH）浓度是确定高皮质醇血症患者潜在病因的重要步骤。免疫分析中的干扰物质可能导致错误结果，影响临床管理。我们描述了一个包含12名患者的病例系列，其中大多数患者正在接受库欣综合征的可能检查，并且他们的临床表现与生化检测结果之间的不一致引发了对检测干扰的担忧。使用西门子Immulite检测法时，ACTH检测干扰导致ACTH浓度错误升高，进而导致了额外的不必要检测。医生与实验室之间的沟通以及适当的调查（包括样本稀释、使用封闭抗体和在另一个平台上进行检测）导致了检测干扰的识别。识别临床上存在差异的生化结果仍然是患者评估的关键步骤。
