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A Man with Abdominal Pain: Enough Evidence for Surgery?

The apparent simplicity of this assay format belies its sensitivity to assay interference. Because ACTHsecreting pancreatic tumors are rare entities and because our patient had little clinical evidence to match the laboratory anomaly, our first priority was to validate the result for ACTH. Human ant...

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Published in:Clinical chemistry (Baltimore, Md.) Md.), 2012-08, Vol.58 (8), p.1187-1190
Main Authors: BOLSTAD, Nils, KAZARYAN, Airazat M, REVHEIM, Mona-Elisabeth, DISTANTE, Sonia, JOHNSRUD, Kjersti, WARREN, David J, NUSTAD, Kjell, EDWIN, Bjorn
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Language:English
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Summary:The apparent simplicity of this assay format belies its sensitivity to assay interference. Because ACTHsecreting pancreatic tumors are rare entities and because our patient had little clinical evidence to match the laboratory anomaly, our first priority was to validate the result for ACTH. Human antianimal antibodies produced in response to therapeutic immunoglobulins are an additional source of assay interference.\n These observations strongly suggested that Fcreactive heterophilic antibodies were present in the sample. Because the Immulite assay for ACTH is designed with a monoclonal murine antibody in combination with a polyclonal rabbit antibody, we also established a nonsense assay with a polyclonal rabbit immunoglobulin as the solid phase with a mouse monoclonal tracer. The pancreatic tumor identified by the 68Ga- DOTATOC PET/CT evaluation warranted further scrutiny. Because of its enhanced affinity for somatostatin receptors and improved spatial resolution, 68Ga-DOTATOC PET/CT is reportedly superior to conventional imaging with 111In-DTPA-octreotide SPECT in detecting neuroendocrine tumors (9 ).
ISSN:0009-9147
1530-8561
DOI:10.1373/clinchem.2011.167015