Falsely elevated parathyroid hormone in a patient with osteoporosis: a case report and review

We report a case of falsely high PTH levels due to assay interference and review the literature on cases of spuriously elevated PTH.Case reportAn 87-year-old woman attending our bone health clinic with osteoporosis had persistently elevated PTH (383 –784 pg/ml) using the Roche Cobas e801 immunoassay despite having normal serum calcium, phosphate, 25 hydroxyvitamin D (>  50 nmol/l) and eGFR (>  60 ml/min). To rule out falsely elevated PTH, a polyethylene glycol precipitation (PEG) test was performed which recovered less than 10% of the hormone resulting in a normal level. PTH was also tested on a different assay (Atellica Siemens) that identified a result of 27 pg/ml. The findings wer e consistent with immunoassay interference likely due to heterophile antibodies giving rise to a spuriously high PTH.DiscussionThe presence of unexpectedly high PTH levels should alert physicians to the possibility of false results due to assay interference or macro-PTH. This highlights the importance of clinically correlating results and of good communication with the testing laboratory.SummaryHere, we present the case of an 87-year-old woman with spuriously elevated PTH levels due to immunoassay interference likely mediated by heterophile antibodies. The presence of unexpectedly high PTH levels should prompt consideration of the possibility of false results due to assay interference or macro-PTH.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research