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Bisalbuminemia is a rare, typically benign condition marked by the presence of a bifid albumin band on serum protein electrophoresis. It can either be inherited due to a point mutation or acquired in association with various medical conditions, most commonly diabetes mellitus. Bisalbuminuria, the presence of bifid albumin in urine, may or may not accompany bisalbuminemia. Both conditions are often discovered incidentally during screening for monoclonal gammopathy. Bisalbuminemia and related variants provide insights into albumin's genetic diversity and functional roles, influencing clinical diagnostics and research in human genetics. Understanding these variants aids in distinguishing benign conditions from potential disease states, guiding appropriate clinical management. In this case-based review, we present a case of hereditary bisalbuminemia identified unexpectedly during an investigation of a positive Direct Antiglobulin Test Coombs in an adult female patient. This review aims to highlight the key features of bisalbuminemia, a rare condition that should be recognized by clinicians.

Bisalbuminemia is a rare, typically benign condition marked by the presence of a bifid albumin band on serum protein electrophoresis. It can either be inherited due to a point mutation or acquired in association with various medical conditions, most commonly diabetes mellitus. Bisalbuminuria, the presence of bifid albumin in urine, may or may not accompany bisalbuminemia. Both conditions are often discovered incidentally during screening for monoclonal gammopathy. Bisalbuminemia and related variants provide insights into albumin's genetic diversity and functional roles, influencing clinical diagnostics and research in human genetics. Understanding these variants aids in distinguishing benign conditions from potential disease states, guiding appropriate clinical management. In this case-based review, we present a case of hereditary bisalbuminemia identified unexpectedly during an investigation of a positive Direct Antiglobulin Test Coombs in an adult female patient. This review aims to highlight the key features of bisalbuminemia, a rare condition that should be recognized by clinicians., Competing Interests: The authors declare no conflict of interest., (© 2024 Published by Elsevier Inc.)

This article discusses the conditions that may lead to a phenomenon called dysthyronemia. Here, the thyroid gland has concentration of thyrotropin in circulation within the reference range, but the concentrations of free or total fractions of thyroid hormones are outside the reference range. Normal values of thyrotropin (TSH) and increased values of THs are referred to as hyperthyroxinemia, while normal values of thyrotropin and decreased values of thyroid hormone are hypothyroxinemia. As shown by our observations, it is a relatively frequent situation in the parallel determinations of TSH and free thyroxine, when results verging on hyperthyroxinemia were found in 7% of cases (6.74%, n=259,590), and also in the parallel sets of TSH and total triiodothyronine when hypotriiodothyroninemia reached 8.5% (8.48%, n=73,143). We are assuming that the main cause of hyperthyroxinemia in the free thyroxine and TSH system is the presence of autoantibodies against thyroxine in patients with autoimmune thyroid disease. The reason of hypotriiodothyroninemia in the system of triiodothyronine and TSH is a decreased concentration of thyroid binding globulin in postmenopausal women. Manufacturers of immunoanalytical kits should take into account the potential adverse effects of autoantibodies against thyroid hormones when measuring the results of immunoassay determination of the free fraction of these hormones. [ABSTRACT FROM AUTHOR]

Background: Dysthyronemia is the state of the thyroid gland in which the concentration of thyrotropin (TSH) in circulation is within the reference range, but the concentrations of free or total fractions of thyroid hormones (TH) are outside the reference range. Normal values of TSH and increased values of TH are referred to as hyperthyroxinemia or hypertriiodothyroninemia, while normal values of TSH and decreased values of TH are called hypothyroxinemia or hypotriiodothyroninemia. Methods: Thyroid diagnostic tests were carried out at the Institute of Endocrinology, Prague, Czech Republic, in 1999-2009 using the immunoanalytical systems of Roche Diagnostics GmbH, Germany (Elecsys 2010, Modular E170). Results: Hyperthyroxinemia was found in 6.74% of all parallel sets of TSH and free thyroxine (FT4, n=259,590) values. Hypotriiodothyroninemia was observed in 8.48% of all parallel sets of TSH and total triiodothyronine (TT3, n=73,143). The occurrence of hyperthyroxinemia (TSH-FT4) and hypotriiodothyroninemia (TSH-TT3) was >3 times higher than the occurrence of dysthyronemia for the combinations TSH-FT4 (hypothyroxinemia), TSH-TT4 (total thyroxine, n=1996), TSH-FT3 (free triiodothyronine, n=94,090), and TSH-TT3 (hypertrijodthyroninemia), and >5 times higher in comparison with the combinations TSH-FT4-FT3 (n=93,683), TSH-FT4-TT3 (n=72,373), TSH-FT3-TT3 (n=2466), TSH-TT4-TT3 (n=1779), TSH-FT4-TT4 (n=1571), and TSH-FT3-TT4 (n=1466). Conclusion: In light of our patient types, we are assuming that the observed hypotriiodothyroninemia (TSH-TT3, 8.48%) is due to a decreased concentration of thyroid binding globulin in postmenopausal women and that hyperthyroxinemia (TSH-FT4, 6.74%) is caused mainly by endogenous autoantibodies against thyroxine in patients with thyroid autoimmune diseases. [ABSTRACT FROM AUTHOR]