{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T19:30:46Z","timestamp":1785180646314,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":165,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>An 11-year-old girl presented to the emergency department with hypophosphataemia. Subsequent investigations repeatedly demonstrated elevated serum parathyroid hormone (PTH) associated with normal serum total calcium, phosphate, vitamin D, and bone turnover markers. Imaging studies were initially interpreted as being consistent with the effects of hyperparathyroidism; however, follow-up review by specialists with paediatric expertise concluded otherwise. Further laboratory studies ultimately demonstrated that there was a false elevation in PTH, determined to be due to interference in the PTH assay from the formation of macromolecular complexes. This case highlights the effects of a phenomenon known as \u2018Ulysses syndrome\u2019, whereby a patient is sent on an unnecessary journey of extensive diagnostic investigation conducted because of a false-positive result. Recognition of macromolecular complexes and antibody interferences in patients with PTH results that are discordant with the overall clinical picture and other biochemistry results may prevent this phenomenon, with all its psychological and financial consequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0097","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T19:07:13Z","timestamp":1773860833000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Truly elevated PTH or Ulysses syndrome?"],"prefix":"10.1530","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3052-2613","authenticated-orcid":true,"given":"Sandhya","family":"Ramakrishna","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Visser","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Salib","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Rita","family":"Horvath","sequence":"additional","affiliation":[{"name":"4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bonnitcha","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026070713532838500_bib1","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1515\/cclm-2021-1288","article-title":"Interferences in immunoassays: review and practical algorithm","volume":"60","author":"Wauthier","year":"2022","journal-title":"Clin Chem Lab Med"},{"key":"2026070713532838500_bib2","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s40618-023-02049-9","article-title":"Macro-PTH, a rare cause of unexplained elevated serum PTH levels","volume":"46","author":"Cetani","year":"2023","journal-title":"J Endocrinol Investig"},{"key":"2026070713532838500_bib3","first-page":"CC4","article-title":"Asymptomatic elevated PTH level due to immunoassay interference resulting from macro-PTH: a case report","volume":"44","author":"Prodan","year":"2016","journal-title":"Endocr Abstr"},{"key":"2026070713532838500_bib4","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1515\/cclm-2024-0455","article-title":"Spurious parathyroid hormone (PTH) elevation caused by macro-PTH","volume":"62","author":"Lavalleye","year":"2024","journal-title":"Clin Chem Lab Med"},{"key":"2026070713532838500_bib5","first-page":"122","article-title":"The Ulysses syndrome","volume":"106","author":"Rang","year":"1972","journal-title":"Can Med Assoc J"},{"key":"2026070713532838500_bib6","doi-asserted-by":"crossref","first-page":"1499-a","DOI":"10.1176\/appi.ajp.161.8.1499-a","article-title":"Hypophosphatemia in panic disorder","volume":"161","author":"Roestel","year":"2004","journal-title":"Am J Psychiatr"},{"key":"2026070713532838500_bib7","doi-asserted-by":"crossref","DOI":"10.1016\/j.amjsurg.2024.115812","article-title":"Normocalcemic primary hyperparathyroidism: from pathophysiology to clinical management","volume":"235","author":"Wu","year":"2024","journal-title":"Am J Surg"},{"key":"2026070713532838500_bib8","doi-asserted-by":"crossref","first-page":"e868","DOI":"10.1210\/clinem\/dgae659","article-title":"Approach to the patient: normocalcemic primary hyperparathyroidism","volume":"10","author":"Liu","year":"2025","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070713532838500_bib9","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jocd.2020.01.006","article-title":"DXA in children and adolescents","volume":"24","author":"Guss","year":"2021","journal-title":"J Clin Densitom"},{"key":"2026070713532838500_bib10","article-title":"Macroprolactinemia: diagnostic, clinical, and pathogenic significance","volume":"2012","author":"Shimatsu","year":"2012","journal-title":"J Immunol Res"}],"container-title":["Endocrinology, Diabetes &amp; 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