Abstract
Abstract Background This report investigates an unusual total testosterone result in a middle-aged female. Case presentation A 40-year-old female patient was found to have high serum total testosterone of 30.82 nmol/L on a Beckman Coulter UniCel® DxI800 automatic chemiluminescence immunoanalyzer without appropriate clinical appearance. Heterophile antibody interference was considered for elevated testosterone and investigated; reanalysis of the original serum sample and liquid chromatography with tandem mass spectrometry (LC-MS/MS) were performed. Reanalysis of the original serum sample using Roche® and Siemens® immunoassays both gave a normal total testosterone level. Beckman Coulter® also excluded the possibility of interference by heterophile antibodies. Finally, LC-MS/MS showed that the total testosterone level was in the normal range. Conclusions This report highlights the importance of ruling out the interfering factors for false high values of the analyte in laboratories.
Highlights
Testosterone is the principal androgen hormone, produced mainly by the Leydig cells in males
Heterophile antibody interference was considered for elevated testosterone and investigated; reanalysis of the original serum sample and liquid chromatography with tandem mass spectrometry (LC-MS/MS) were performed
LC-MS/MS showed that the total testosterone level was in the normal range
Summary
Testosterone is the principal androgen hormone, produced mainly by the Leydig cells in males. Total testosterone levels are routinely assessed by the automated Access Testosterone assay, a competitive binding immunometric assay performed using the Unicel® DxI 800 (Beckman Coulter, Brea, CA, USA) platform These tests are prone to interference by proteins in the patient’s blood (such as heterophile antibodies and binding proteins) and androgenic compounds. The laboratory tests resulted in normal hormone values except an elevated total testosterone level. Other investigations were normal, including routine biochemistry (e.g. albumin, total protein, etc.), protein electrophoresis, a full blood count, thyroid function, tumor markers, serum osteocalcin, parathyroid hormone, plasma cortisol and adrenal cortical hormone (ACTH). Two months earlier, her total testosterone level was 29.13 nmol/L. The patient had a normal total testosterone level and the result was consistent with her clinical presentation
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