{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T15:47:37Z","timestamp":1764604057513,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,1,16]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>A woman in her late 50s with recent onset of hypertension, diabetes, lumbar pain and unintentional weight loss was diagnosed with a cortisol and androgen-producing adrenal mass. Despite this, serum adrenocorticotropic hormone (ACTH) concentration was inappropriately elevated, which was investigated thoroughly. Investigations included a brain magnetic resonance imaging to exclude concomitant pituitary adenoma, a corticotropin-releasing hormone stimulation test and a gallium-<jats:italic>68 DOTATATE<\/jats:italic> and 18F-FDOPA PET scan, both excluding ectopic ACTH production. Considering the disparity between clinical presentation and biochemical results, the ACTH was reanalysed using the Cobas immunoassay (Roche, Switzerland), ultimately unveiling the cause for ACTH elevation. ACTH levels had previously been measured with ACTH Immulite (Siemens, Germany), a two-site immunoassay which is prone to interferences causing falsely elevated ACTH concentrations. Inaccurate laboratory levels can lead to diagnosis delay and unnecessary diagnostic procedures and a close communication between the physicians and laboratorians is of utmost importance.<\/jats:p>","DOI":"10.1136\/bcr-2023-257320","type":"journal-article","created":{"date-parts":[[2024,2,10]],"date-time":"2024-02-10T04:35:19Z","timestamp":1707539719000},"page":"e257320","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Immunoassay interferences: laboratory pitfall in the diagnosis of adrenocortical carcinoma"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1260-5570","authenticated-orcid":false,"given":"Mafalda","family":"Martins Ferreira","sequence":"first","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Moreno","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patr\u00edcia","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Paiva","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universit\u00e1rio de Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,10]]},"reference":[{"key":"2025082702021589000_17.2.e257320.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2006.02.045"},{"key":"2025082702021589000_17.2.e257320.2","doi-asserted-by":"publisher","DOI":"10.1177\/0004563213487514"},{"key":"2025082702021589000_17.2.e257320.3","doi-asserted-by":"crossref","first-page":"23247096221103368","DOI":"10.1177\/23247096221103368","article-title":"A Pitfall of falsely elevated ACTH: a case report and literature review","volume":"10","author":"Yang","year":"2022","journal-title":"J Investig Med High Impact Case Rep"},{"key":"2025082702021589000_17.2.e257320.4","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1210\/js.2019-00027","article-title":"Assay-specific Spurious ACTH results lead to misdiagnosis, unnecessary testing, and surgical misadventure-A case series","volume":"3","author":"Greene","year":"2019","journal-title":"J Endocr Soc"},{"key":"2025082702021589000_17.2.e257320.5","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.clinbiochem.2018.11.006","article-title":"Corticotropin hormone assay interference: a case series","volume":"63","author":"Donegan","year":"2019","journal-title":"Clin Biochem"},{"key":"2025082702021589000_17.2.e257320.6","first-page":"105","article-title":"Interferences in immunoassay","volume":"25","author":"Tate","year":"2004","journal-title":"Clin Biochem Rev"},{"key":"2025082702021589000_17.2.e257320.7","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2011.011073"},{"key":"2025082702021589000_17.2.e257320.8","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.beem.2013.05.011","article-title":"Heterophilic antibody interference in immunometric assays","volume":"27","author":"Bolstad","year":"2013","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"2025082702021589000_17.2.e257320.9","doi-asserted-by":"publisher","DOI":"10.1258\/000456303322326371"},{"key":"2025082702021589000_17.2.e257320.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02439.x"},{"key":"2025082702021589000_17.2.e257320.11","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.clinbiochem.2020.04.004","article-title":"Evaluation of plasma ACTH stability using the Roche Elecsys immunoassay","volume":"81","author":"Nandakumar","year":"2020","journal-title":"Clin Biochem"},{"key":"2025082702021589000_17.2.e257320.12","unstructured":"RRID. AB_2783635. n.d. Available: https:\/\/scicrunch.org\/resolver\/AB_2783635"},{"key":"2025082702021589000_17.2.e257320.13","unstructured":"RRID. AB_2783634. n.d. Available: https:\/\/scicrunch.org\/resolver\/AB_2783634"},{"key":"2025082702021589000_17.2.e257320.14","unstructured":"RRID. AB_2783633. n.d. Available: https:\/\/scicrunch.org\/resolver\/AB_2783633"},{"key":"2025082702021589000_17.2.e257320.15","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2019.306365"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-257320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:02:23Z","timestamp":1756285343000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-257320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":15,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,10]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bcr-2023-257320"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-257320","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}