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

BACKGROUND: Parathyroid hormone (PTH) measurements can be falsely elevated due to the hormone binding to other molecules (macro-PTH) or immunoassay interference with heterophile, human anti-animal or other antibodies. This is rare but could lead to incorrect diagnosis, unnecessary investigations or avoidance of teriparatide treatment. We report a case of falsely high PTH levels due to assay interference and review the literature on cases of spuriously elevated PTH. CASE REPORT: An 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 were consistent with immunoassay interference likely due to heterophile antibodies giving rise to a spuriously high PTH. DISCUSSION: The 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. Here, 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.

A first-level evaluation of a school-based family programme for adolescent social, emotional and behavioural difficulties.

This study is a first-level evaluation of an intervention targeted at adolescents with social, emotional and behavioural difficulties in Irish post-primary schools. It is a combined implementation of the Working Things Out adolescent programme and the Parents Plus Adolescent Programme (WTOPPAP). Overall, 47 parents and their children (mean age: 13.81 years) took part in the study. The study used a repeated measures design to assess change at pre- and post-intervention and 5-month follow-up using the Strengths and Difficulties Questionnaire, McMaster General Functioning Scale, Goal Attainment (parent- and adolescent-rated), Parent Stress Scale and Kansas Parenting Satisfaction Scale (parent-rated) as assessment measures. This study found that parent-rated child total difficulties and adolescent-rated emotional difficulties significantly improved from pre-test to 5-month follow-up. Parent- and adolescent-rated goals, and parent-rated child conduct difficulties, parental stress and satisfaction with parenting also significantly improved from pre- to post-test. These gains were largely maintained at 5-month follow-up. These findings indicate that the WTOPPAP may be an effective intervention for adolescents with emotional and behavioural difficulties and their parents. It was demonstrated that a manualised family intervention could be effectively rolled out at a number of school locations, with delivery and evaluation being conducted by school staff. Further implications are also discussed.