Pharmacological and analytical interference in hormone assays for diagnosis of adrenal incidentaloma

Lopez, Antoine-Guy; Fraissinet, François; Lefebvre, Henri; Brunel, Valéry; Ziegler, F.

doi:10.1016/j.ando.2018.11.006

Cited by 12 publications

(9 citation statements)

References 72 publications

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“…In a competitive immunoassay, the cross-reactant usually induces a false increase (except in one estriol immunoassay, owing to a particular design [13]). Notably, direct steroid immunoassays (without an extraction step of the sample with an organic solvent) can be affected by cross-reaction (e.g., cortisol metabolites, synthetic glucocorticoids in cortisol immunoassays) [14]. In testosterone concentration measurements, second-generation immunoassays avoid dehydroepiandrosterone sulfate (DHEAS) cross-reaction [15,16].…”

Section: Cross-reaction/assay Specificitymentioning

confidence: 99%

Hormone Immunoassay Interference: A 2021 Update

et al. 2022

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Immunoassays are powerful qualitative and quantitative analytical techniques. Since the first description of an immunoassay method in 1959, advances have been made in assay designs and analytical characteristics, opening the door for their widespread implementation in clinical laboratories. Clinical endocrinology is closely linked to laboratory medicine because hormone quantification is important for the diagnosis, treatment, and prognosis of endocrine disorders. Several interferences in immunoassays have been identified through the years; although some are no longer encountered in daily practice, cross-reaction, heterophile antibodies, biotin, and anti-analyte antibodies still cause problems. Newer interferences are also emerging with the development of new therapies. The interfering substance may be exogenous (e.g., a drug or substance absorbed by the patient) or endogenous (e.g., antibodies produced by the patient), and the bias caused by interference can be positive or negative. The consequences of interference can be deleterious when clinicians consider erroneous results to establish a diagnosis, leading to unnecessary explorations or inappropriate treatments. Clinical laboratories and manufacturers continue to investigate methods for the detection, elimination, and prevention of interferences. However, no system is completely devoid of such incidents. In this review, we focus on the analytical interferences encountered in daily practice and possible solutions for their detection or elimination.

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Section: Cross-reaction/assay Specificitymentioning

confidence: 99%

Hormone Immunoassay Interference: A 2021 Update

et al. 2022

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“…In recent times, autonomous cortisol and aldosterone producing tumours have required not only a hormonal confirmation, but also an immunohistochemistry report (as suggested by modern pathological approach of PA according to 2022 WHO), and, additionally, a molecular genetic workup in selected cases [ 20 , 37 , 38 , 39 , 40 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

“…The individual scenario of Connshing syndrome detection may start from any of the indications to test Conn or Cushing syndrome, such as uncontrolled/resistant HBP, accidental detection of an adrenal neoplasia by performing different abdominal imaging procedures (adrenal incidentaloma), hormonal assays for patients with HBP and diabetes mellitus, osteoporotic fractures, evaluation for newly detected hipercortisolemia, hyperaldosteronism, etc. [ 35 , 37 , 38 , 39 , 41 , 42 , 43 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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Connshing syndrome (CoSh) (adrenal-related synchronous aldosterone (A) and cortisol (C) excess) represents a distinct entity among PA (primary hyperaldosteronisms) named by W. Arlt et al. in 2017, but the condition has been studied for more than 4 decades. Within the last few years, this is one of the most dynamic topics in hormonally active adrenal lesions due to massive advances in steroids metabolomics, molecular genetics from CYP11B1/B2 immunostaining to genes constellations, as well as newly designated pathological categories according to the 2022 WHO classification. In gross, PA causes 4–10% of all high blood pressure (HBP) cases, and 20% of resistant HBP; subclinical Cushing syndrome (SCS) is identified in one-third of adrenal incidentalomas (AI), while CoSh accounts for 20–30% to 77% of PA subjects, depending on the tests used to confirm autonomous C secretion (ACS). The clinical picture overlaps with PA, hypercortisolemia being mild. ACS is suspected in PA if a more severe glucose and cardiovascular profile is identified, or there are larger tumours, ACS being an independent factor risk for kidney damage, and probably also for depression/anxiety and osteoporotic fractures. It seems that one-third of the PA-ACS group harbours mutations of C-related lines like PRKACA and GNAS. A novel approach means we should perform CYP11B2/CYP11B1 immunostaining; sometimes negative aldosteronoma for CYP11B1 is surrounded by micronodules or cell clusters with positive CYP11B1 to sustain the C excess. Pitfalls of hormonal assessments in CoSh include the index of suspicion (check for ACS in PA patients) and the interpretation of A/C ratio during adrenal venous sample. Laparoscopic adrenalectomy is the treatment of choice. Post-operative clinical remission rate is lower in CoSh than PA. The risk of clinically manifested adrenal insufficiency is low, but a synthetic ACTH stimulating testing might help to avoid unnecessary exposure to glucocorticoids therapy. Finally, postponing the choice of surgery may impair the outcome, having noted that long-term therapy with mineralocorticoids receptors antagonists might not act against excessive amounts of C. Awareness of CoSh improves management and overall prognosis.

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“…The rate of malignancy varies with the inclusion criteria of studied population (2). It is low for pituitary incidentalomas but it increases to 5 % for adrenal incidentalomas based on some analyses (2,4,5). Usually there is no hormonal activity at the level of an incidentaloma but controversies around the definition are still running (4,6,7).…”

Section: Introductionmentioning

confidence: 99%

“…It is low for pituitary incidentalomas but it increases to 5 % for adrenal incidentalomas based on some analyses (2,4,5). Usually there is no hormonal activity at the level of an incidentaloma but controversies around the definition are still running (4,6,7). Positive endocrine activity is an indication of tumor removal (8,9).…”

Section: Introductionmentioning

confidence: 99%