Insulin Immunoassay Interference Due to Human Antimouse Antibodies in a Patient With Ketotic Hypoglycemia.
JCEM Case Rep
; 1(2): luad029, 2023 Mar.
Article
en En
| MEDLINE
| ID: mdl-37908465
ABSTRACT
Misinterpretation of common endocrine hormonal immunoassays can distort the clinical picture and lead to unnecessary medical workups. Potential assay inference is important to recognize when the clinical presentation and laboratory evaluation are inconsistent. This is demonstrated by the case of an 18-month-old girl who initially presented with ketotic hypoglycemia and was found on diagnostic fasting evaluation to have the triad of hypoglycemia, inappropriately high insulin levels, and low C-peptide levels-point-of-care glucose 43â
mg/dL (2.39â
mmol/L) (confirmatory 52â
mg/dL [2.89â
mmol/L]), insulin 48.1 µIU/mL (334â
pmol/L), and C-peptide 0.2 ng/mL (0.07â
nmol/L) concerning for factitious insulin (insulinC-peptide ratio 4.77). On repeat diagnostic fast, insulin assays measured by liquid chromatography-mass spectrometry were incongruent with prior testing by immunoassay, demonstrating a falsely elevated insulin level when measured by immunoassay, likely due to human antimouse antibody interference (HAMA 181â
ng/mL). This case represents a diagnostic challenge in which is it imperative to recognize possible immunoassay interference. It is critical to establish the difference between insulin assay interference and factitious insulin through use of alternative laboratory methods as misdiagnosis could lead to the serious implication of Munchausen by proxy resulting in the removal of a child from their home and potentially parents being charged with a crime.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Idioma:
En
Revista:
JCEM Case Rep
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos