An important case pointing to the endocrinologist’s dilemma when facing inappropriate or discordant hormonal results. This patient had severely high levels of serum estradiol, progesterone, testosterone, and cortisol in complete absence of clinical signs and symptoms.
Mass spectrometry, an expensive and poorly available analytical technique, saved the day. Mild monoclonal IgG elevation (hypergammaglobulinemia) was felt to be the interfering agent leading to falsely high hormone measures. Interference could also occur in the setting of heterophilic antibodies, rheumatoid factor and biotin intake, none which were present in this case.
Important to be aware of false deviations in blood work, as inability to realize it could generate unnecessary anxiety, testing, imaging, procedures and even intervention.
GT