Reference range of serum calcitonin levels in humans: influence of calcitonin assays, sex, age, and cigarette smoking

d’Herbomez, Michèle; Caron, Philippe; Bauters, Christophe; Cao, Christine Do; Schlienger, Jean-Louis; Sapin, R; Baldet, L; Carnaille, B.; Wémeau, Jean-Louis

doi:10.1530/eje-07-0566

Cited by 113 publications

(99 citation statements)

References 39 publications

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“…Basal median serum Ct as well as median calcitonin-AUC were higher in men when compared to women. These results are in agreement with the findings of d' Herbomez et al, 8 who reported that serum Ct levels are higher in normal men when compared to women. In the subgroup of participants in whom serum cortisol increased during GTT, serum Ct increased significantly by 42% at 30 min compared to an increase by 17% in the participants in whom serum cortisol decreased.…”

Section: Discussionsupporting

confidence: 93%

Hyperinsulinemia during oral glucose tolerance test and high normal serum cortisol are associated with increased secretion of calcitonin in normal subjects

Polymeris¹,

Papapetrou²,

Papandroulaki³

et al. 2011

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ObJEctIVE: Previous studies showed that insulin stimulated directly calcitonin (ct) secretion in the pig thyroid, while dexamethasone stimulated the production of ct and ct mrNA in medullary thyroid carcinoma (Mtc) cell lines. the objective of this study was to investigate if hyperinsulinemia during the oral glucose tolerance test (Gtt) stimulates ct secretion in normal subjects as well as to examine the relationship between serum cortisol and ct. DEsIGN: In 26 normal subjects (9 men and 17 women) with detectable basal serum ct, aged 22-70 yr [51.5±14.6 (mean±SD), median 55.5], we measured serum or plasma ct, cortisol, ActH, insulin, and blood glucose before (0 min) and at 30, 60, 90, and 120 min after ingestion of 75 g glucose. rEsULts: During Gtt mean serum cortisol increased slightly by 9.3% at 30 min, whereas mean serum insulin increased 9.4-fold, reaching a peak value at 60 min. Median serum Ct increased by 51% (p<0.001) in normal subjects (by 27% in men, p=0.004, and by 44% in women, p<0.001) at 30 min and remained significantly higher thereafter (up to 120 min) when compared to median baseline level. regression analysis showed that basal serum cortisol, but not basal serum insulin, was correlated with basal serum ct (p=0.01). Peak concentrations of Ct were also correlated with peak concentrations of cortisol at 30 min (p<0.001) but not at later time points. serum insulin was correlated with serum ct at the serum insulin peak level (60 min), and at later time points (90 and 120 min) (p=0.001). Multiple and simple regression analysis showed that calcitonin-AUc (Area Under curve) values correlated with insulin-AUc (p=0.003), and also with cortisol-AUc (p=0.02) values, the standardized effect of insulin-AUc on calcitonin-AUc being greater than that of cortisol-AUc. cONcLUsIONs: these findings suggest that acute hyperinsulinemia during Gtt is very likely associated with increased ct secretion in normal subjects. serum cortisol within the physiological range was also correlated with serum ct under basal conditions, as well as during Gtt.

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Section: Discussionsupporting

confidence: 93%

Hyperinsulinemia during oral glucose tolerance test and high normal serum cortisol are associated with increased secretion of calcitonin in normal subjects

Polymeris¹,

Papapetrou²,

Papandroulaki³

et al. 2011

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“…Calcitonin (CT) 12 is an extremely sensitive marker for both the initial diagnosis and follow-up of patients with medullary thyroid cancer (MTC) (1)(2)(3)(4)(5). Sandwich immunoassays are applied when measuring CT in the clinical laboratory.…”

confidence: 99%

Basal and Stimulated Calcitonin and Procalcitonin by Various Assays in Patients with and without Medullary Thyroid Cancer

Kratzsch

Petzold

Raue³

et al. 2011

Clinical Chemistry

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BACKGROUND Calcitonin (CT) is a sensitive marker for evaluation of medullary thyroid cancer (MTC). However, CT measurement can vary with assay- and nonassay-dependent factors, and procalcitonin (PCT) measurement has been proposed for evaluating questionable increases in CT. METHODS We tested 2 fully automated CT assays (Immulite [IL] and Liaison [LIA]) and 1 nonautomated CT assay (IRMA, Medipan) and compared these results with PCT (Brahms Kryptor). We evaluated preanalytical conditions and PCT cross-reactivity in sera of 437 patients with clinical conditions associated with hypercalcitoninemia. Additionally, we determined the true “nil” CT concentration in 60 thyroidectomized patients and defined CT cutoff concentrations for pentagastrin stimulation testing in 13 chronic kidney disease (CKD) patients and 10 MTC patients. RESULTS Markedly decreased CT concentrations were found after storage of sera for >2 h at room temperature and >6 h at 4 °C. Cutoff concentrations for basal and stimulated CT were disease and assay dependent. Proton pump inhibitor therapy was the most frequent reason for increased CT. PCT concentrations were higher in patients with MTC than in patients with CKD without infections (P < 0.001). Whereas IL and LIA demonstrated comparable analytical quality, the IRMA gave increased CT concentrations in nil sera and showed cross-reactivity with PCT in patients with concomitant bacterial infection. CONCLUSIONS IL, LIA, and IRMA detected increased CT concentrations in non-MTC patients and discriminated MTC from CKD patients in pentagastrin tests. PCT assessment may be helpful in the diagnostic work-up of increased CT concentrations in questionable clinical circumstances.

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“…In addition, different analytical, physiological, pharmacological and pathological factors may significantly reduce the specificity and overall accuracy of serum CT measurement 3. Due to the influence of these factors, there is a high variability in assay‐dependent and gender‐dependent cut‐offs used to discriminate between MTC, C‐cell hyperplasia (CCH) and healthy C cells 10. Additionally, CT is prone to in vitro decay at room temperature which makes rapid centrifugation and storage at −20°C of samples mandatory 11, 12…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

Giovanella

Imperiali

Piccardo

et al. 2018

Eur J Clin Investigation

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BackgroundTo prospectively evaluate the role of procalcitonin (PCT) in screening of patients with thyroid nodules for medullary thyroid carcinoma (MTC).Materials and methodsWe measured PCT in 2705 patients with thyroid nodules referred to our centre between January 2011 and December 2017. Those with a positive PCT were operated after positive confirmatory tests such as fine‐needle aspiration, measurement of calcitonin (CT) in serum and fine‐needle aspiration washouts or CT stimulation testing. Patients with a negative PCT were operated based on the results of further diagnostics. The diagnostic performance of PCT was evaluated, and the best cut‐off level was selected by ROC curve analysis.ResultsAmong 2705 patients, 9 with positive serum PCT (ie, above 0.1 μg/L) and 370 with negative PCT underwent thyroid surgery. MTC was histologically confirmed in all patients with positive PCT but not found in patients with negative PCT. Serum PCT levels were significantly higher in patients with MTC (median 0.64 μg/L, range 0.16‐12.9 μg/L) than in those without (median 0.075 μg/L, range 0.075‐0.16 μg/L; P < .0001). ROC curves were plotted to calculate the optimal PCT value separating patients with MTC from those without. The best cut‐off was 0.155 μg/L with sensitivity, specificity, positive and negative predictive values as well as accuracy of 100%, 99.7%, 91.7%, 100% and 99.7%, respectively. Positive and negative likelihood ratios were 329 and zero, respectively.ConclusionsMeasurement of PCT is a sensitive and accurate method for detecting MTC in patients with thyroid nodules and can thus be a reliable alternative to CT measurement.

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Reference range of serum calcitonin levels in humans: influence of calcitonin assays, sex, age, and cigarette smoking

Cited by 113 publications

References 39 publications

Hyperinsulinemia during oral glucose tolerance test and high normal serum cortisol are associated with increased secretion of calcitonin in normal subjects

Hyperinsulinemia during oral glucose tolerance test and high normal serum cortisol are associated with increased secretion of calcitonin in normal subjects

Basal and Stimulated Calcitonin and Procalcitonin by Various Assays in Patients with and without Medullary Thyroid Cancer

Procalcitonin measurement to screen medullary thyroid carcinoma: A prospective evaluation in a series of 2705 patients with thyroid nodules

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