Assay-Specific Spurious ACTH Results Lead to Misdiagnosis, Unnecessary Testing, and Surgical Misadventure—A Case Series

• DOI: 10.1210/js.2019-00027
• Publication Date: 2019-02-21T02:36:10Z
• Authors: Loren Wissner Greene; Eliza B Geer; Gabrielle Page-Wi...; James W Findling; Hershel Raff
• Keywords: Spurious relationship; Lead (geology)

The proper clinical evaluation of pituitary and adrenal disorders depends on the accurate measurement plasma ACTH. modern two-site sandwich ACTH immunoassay is a great improvement compared with older methods but still has potential for interferences such as heterophile antibodies pro-opiomelanocortin (POMC) fragments. We report cases five patients in whom diagnosis or differential Cushing syndrome was confounded by erroneously elevated results from Siemens Immulite assay [ACTH(Immulite)] that were resolved using Roche Cobas Tosoh AIA [ACTH(Cobas) ACTH(AIA), respectively]. In one case, falsely ACTH(Immulite) owing to interfering resulted several invasive diagnostic procedures (including inferior petrosal sinus sampling), MRI, unnecessary surgery. ACTH(Cobas) measurements normal, further studies excluded syndrome. three cases, either disease occult ectopic suspected results. However, (ACTH-independent) established ACTH(AIA) proved surgically. results; however, findings led alcohol-induced hypercortisolism abstinence. have concluded can be increased alternate assays should used hypothalamic-pituitary-adrenal axis.