On this forum, we have become familiar with the occurrence of interference with laboratory tests. Probably the most discussed in recent times ahs been that of biotin on tests which use streptin-avidin.
Although the interference reported is not directly thyroid, sex hormones are very frequently discussed here.
This short article says: Analytical interference and laboratory error should be suspicious at first when the clinical characteristics contradict the laboratory results of serum hormones. Which, as far as it goes, makes sense. But we need to be careful that we don't find ourselves going the other way and never suspecting results just because they initially appear compatible with clinical characteristics. Which pretty much means, always to bear in mind that any result, however sensible, could have been affected by interference.
BMC Womens Health
. 2022 Jun 16;22(1):232.
doi: 10.1186/s12905-022-01828-5.
Falsely elevated serum estradiol in woman of reproductive age led to unnecessary intervention and delayed fertility opportunity: a case report and literature review
Jing Zhang 1 2 3 , Liangzhi Xu 1 2 3 , Lin Qiao 4 5 6 7
Affiliations
• PMID: 35710471
• DOI: 10.1186/s12905-022-01828-5
Abstract
Background: The optimal management of patients in reproductive endocrinology relies on the accuracy and validity of sex hormone assays. Endogenous or exogenous substances can compete with the analyte. This competition can result in interfering errors and falsely indicate elevated serum levels. Obvious interference in estradiol assays appears to occur rarely. Consequently, clinicians who are not familiar with the potential of interference could be misled. In addition to unnecessary investigations and interventions and severe mental stress, falsely elevated estradiol results can result in missed or delayed fertility opportunities.
Case: A 28-year-old female with pregnancy demand was diagnosed with polycystic ovary syndrome, Hashimoto's thyroiditis and subclinical hypothyroidism. She was found to have persistently elevated levels of serum estradiol in the early follicular phase (between 527 and 642 pg/mL). Screening workup was performed for nearly 11 months to find the causes. Serum tumor biomarkers were normal. Abdominal and pelvic computed tomography were negative for adrenal or adnexal masses. A left mesosalpinx cyst and benign pathological results were achieved by laparoscopic surgery. Hormonal substances and dietary supplements were absent, as determined by dietary records. Ultrasound confirmed follicles could grow slowly and eventually ovulate. Falsely elevated estradiol levels were suspected due to the discrepancy among high estradiol levels, follicle growth and normal gonadotropin levels. Immunological interference by heterophile antibody was finally verified by two competitive chemiluminescent immunoassay platforms (estradiol levels in the early follicle phase: 619 pg/mL, Siemens ADVIA CENTAUR and 60 pg/mL, Beckman, DxI 800). Successful clinical pregnancy was eventually achieved by combining induced ovulation, ultrasound monitoring and intercourse guidance.
Conclusions: Analytical interference and laboratory error should be suspicious at first when the clinical characteristics contradict the laboratory results of serum hormones. Measuring serum estradiol with another immunoassay platform is an easy and non-time-consuming method to exclude the heterophile interfering.
Keywords: Case report; Competitive chemiluminescent immunoassay; Estradiol; Heterophile antibody; Immunoassay interference.
