Intricate diagnosis due to falsely elevated testosterone levels by immunoassay

• Published in: Endocrine Vol. 88; no. 3; pp. 706 - 710
• Main Authors: Gardini, Benedetta, Bondanelli, Marta, Cariani, Alessio, Zatelli, Maria Chiara, Ambrosio, Maria Rosaria
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2025; Springer Nature B.V
• Subjects: Adult; Aged; Antibodies, Heterophile - blood; Brief Report; Diabetes; Diagnosis; Diagnostic Errors; Endocrinology; False Positive Reactions; Humanities and Social Sciences; Humans; Immunoassay - methods; Internal Medicine; Liquid chromatography; Literature reviews; Male; Mass spectroscopy; Medicine; Medicine & Public Health; Middle Aged; multidisciplinary; Science; Testosterone; Testosterone - blood; Testosterone; Heterophilic antibodies; Hormone immunoassay; Laboratory interferences
• ISSN: 1559-0100; 1355-008X; 1559-0100
• DOI: 10.1007/s12020-025-04191-1

Purpose Hormone immunoassay may be subject to interferences and, although rarely reported, this can occur for testosterone too. This work is aimed to highlight the importance of considering possible analytical interferences when the biochemical data doesn’t match with the clinical picture. Methods We report three cases of insidious diagnosis due to laboratory interference in testosterone immunoassay, and we provide a brief literature review on this issue. Results We found falsely high testosterone levels due to the presence of heterophilic antibodies, leading to unnecessary investigations, misdiagnosis and inappropriate treatments. Conclusion The detection of elevated testosterone levels on immunoassay not corresponding to clinical findings need to be confirmed by liquid chromatography-tandem mass spectroscopy, prior to escalation of complex diagnostic investigation and care.