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Li J, Patton A, Lee JKY, Scheidegger M, Azaryan I, Sipos JA, Nabhan F, Jones J, Algeciras-Schimnich A, Ringel MD. Defining the Functional Sensitivity for the Siemens Atellica Calcitonin Assay: Insight From a Single-Center Study. Endocr Pract 2024:S1530-891X(24)00656-6. [PMID: 39197746 DOI: 10.1016/j.eprac.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/18/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Detectable, and especially rising postthyroidectomy serum calcitonin and carcinoembryonic antigen levels, as per American Thyroid Association guidelines, indicate potential disease presence, requiring frequent calcitonin measurement or imaging for early detection of persistent or recurrent medullary thyroid carcinoma. Thus, defining the clinical cutoff value of detection of calcitonin assays relative to imaging and clinical status is crucial for patient care. This study aimed to evaluate postoperative calcitonin levels using the new Siemens Atellica assay system to determine the most appropriate levels for clinical decision-making. METHODS A retrospective analysis was conducted using Siemens Atellica for calcitonin testing on 56 samples from 40 patients between September 27, 2022 and August 11, 2023. Only calcitonin results performed at least 3 months post-total thyroidectomy were included. Imaging studies, within 6 months of the calcitonin report, were assessed. Carcinoembryonic antigen results were also reviewed. RESULTS Precision analysis at 2.94 and 5.24 pg/mL revealed coefficients of variation at 16.49% and 8.87%, respectively. For the evidence of post-total thyroidectomy persistent or recurrent medullary thyroid carcinoma confirmed by imaging, using a 1.89 pg/mL cutoff for calcitonin yielded 43% sensitivity and 67% specificity. Using a 5.00 pg/mL cutoff resulted in 0% sensitivity and 100% specificity. CONCLUSIONS Our findings indicate the potential suitability of a 5 pg/mL calcitonin cutoff on the Siemens Atellica platform for evaluating tumor persistence or recurrence in post-thyroidectomy patients in our institution. However, individual laboratories should establish their own clinical cutoff value when evaluating calcitonin levels for monitoring tumor recurrence post-thyroidectomy.
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Affiliation(s)
- Jieli Li
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
| | - Ashley Patton
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jason K Y Lee
- Department of Clinical Laboratory, University Hospital, The Ohio State University, Columbus, Ohio
| | - Matt Scheidegger
- Department of Clinical Laboratory, University Hospital, The Ohio State University, Columbus, Ohio
| | - Irina Azaryan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jennifer A Sipos
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - JoAnna Jones
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | | | - Matthew D Ringel
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio; Department of Molecular Medicine and Therapeutics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
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Dralle H, Weber F, Lorenz K, Machens A. [30 years of prophylactic thyroidectomy for hereditary medullary thyroid cancer : A milestone in translational medicine]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:638-650. [PMID: 38806713 PMCID: PMC11286710 DOI: 10.1007/s00104-024-02105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
Medullary thyroid cancer (MTC) is the most frequent manifestation of multiple endocrine neoplasia type 2 (MEN2) that determines the oncological outcome. Germline mutations in the rearranged during transfection (RET) protooncogene, a tumor suppressor gene on chromosome 10q11.2, were identified 30 years ago as the genetic basis of MEN2 and published in 1993 and 1994. These seminal findings gave rise to the concept of prophylactic thyroidectomy for asymptomatic gene mutation carriers based on a positive RET gene test, which has become the standard of care ever since. Clinical genetic investigations showed genotype-phenotype correlations with respect to the individual gene mutation regarding the penetrance and onset of MTC and to a lesser extent also with respect to the other components of MEN2, pheochromocytoma and primary hyperparathyroidism. From this a clinically relevant risk stratification could be derived. Initially, the optimal timing of prophylactic thyroidectomy was primarily based on the RET genotype alone, which was not sufficient for a precise age recommendation and subsequently required additional consideration of calcitonin serum levels for fine tuning. Calcitonin levels first show the risk of lymph node metastasis when they exceed the upper normal limit of the assay independent of carrier age and RET mutation. Routine calcitonin screening of patients with nodular thyroid disease, screening of families on identification of MEN2 index patients, and pre-emptive thyroidectomy in carriers of gene mutations with normal calcitonin levels have led to the fact that nowadays, 30 years after the first description of the gene mutations causing the disease, the life-threatening hereditary MTC has become curable: a shining example for the success of translational transnational medical research for the benefit of patients.
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Affiliation(s)
- Henning Dralle
- Klinik für Allgemein‑, Viszeral-und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Frank Weber
- Klinik für Allgemein‑, Viszeral-und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Kerstin Lorenz
- Klinik für Viszeral‑, Gefäss- und Endokrine Chirurgie, Universitätsmedizin Halle, Ernst Grube Str. 40, 06097, Halle (Saale), Deutschland
| | - Andreas Machens
- Klinik für Viszeral‑, Gefäss- und Endokrine Chirurgie, Universitätsmedizin Halle, Ernst Grube Str. 40, 06097, Halle (Saale), Deutschland
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Liu S, Zhao H, Li X. Serum Biochemical Markers for Medullary Thyroid Carcinoma: An Update. Cancer Manag Res 2024; 16:299-310. [PMID: 38617188 PMCID: PMC11011642 DOI: 10.2147/cmar.s440477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Medullary thyroid carcinoma (MTC), a rare malignancy, requires early diagnosis for optimal patient outcomes. An important aspect of MTC diagnosis is the assessment of serum biomarkers. This review aimed to evaluate the use of serum biomarkers in the diagnosis, prognosis, and follow-up of MTC. Methods A thorough search of PubMed covering 1975 to 2022 was conducted to identify English-language articles on MTC serum biomarkers. Results The review revealed that calcitonin (Ctn) and carcinoembryonic antigen (CEA) remain the most important serum biomarkers for MTC diagnosis and management. Despite limited studies on procalcitonin (PCT), its stability and ability to exclude interference from inflammation make it a valuable potential marker of MTC. Although the positive rate of serum CA19-9 levels in MTC patients was not high, it can be used as an indicator of poor prognosis in advanced MTC. Other serum markers, including chromogranin A, gastrin-releasing peptide precursor, and neurospecific enolase, did not show any unique value in MTC diagnosis and management. Conclusion Taken together, this review emphasized the importance of serum biomarkers, particularly Ctn and CEA, in the diagnosis and management of MTC. PCT shows promise as a valuable potential marker, whereas CA19-9 can be used as a prognostic indicator of advanced MTC. Further research is needed to validate the significance of these serum biomarkers in MTC and determine the effects of confounding factors on their levels. Clinicians should consider using these markers in MTC diagnosis, prognosis, and follow-up, particularly for patients with advanced disease.
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Affiliation(s)
- Shuzhou Liu
- Department of Head & Neck Surgery, Hainan General Hospital, Haikou, 570311, People’s Republic of China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, People’s Republic of China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, People’s Republic of China
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Harutyunyan KR, Abrahamyan HT, Adamyan SH, Mkrtchian S, Ter-Markosyan AS. Calcium-Regulating Hormonal System and HMGB1 in Cardiomyopathies. Endocr Metab Immune Disord Drug Targets 2023; 23:115-121. [PMID: 35980074 DOI: 10.2174/1871530322666220817110538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Calcium ions play a key role in the heart's functional activity. The steadystate levels of calcium are contingent on the calcium regulating hormonal system, impairment of which might result in the development of cardiac pathology. An important role in these processes is also attributed to the specific inflammatory mediator, HMGB1, one of the damage-associated molecular patterns (DAMPs) released by immune cells or cell damage. OBJECTIVE This study investigated the cardioprotective potential of the calcium-regulating hormonal system in cardiomyopathies with an emphasis on the possible role of HMGB1. METHODS Ca2+ and inorganic phosphate levels were determined in the serum using an electrolyte analyzer and spectrophotometric analyzer correspondingly. The 1-34 fragment of parathyroid hormone (PTH), calcitonin, vitamin D, and HMGB1 were detected using ELISA kits. RESULTS The levels of PTH, calcitonin, phosphate, and HMGB1 were found elevated in females suffering from cardiomyopathy. The same tendency was observed in men; however, statistically significant changes were registered only for PTH and phosphate. CONCLUSION It can be suggested that among other reasons, the decrease of the left ventricular function in cardiomyopathy patients can be linked to the high HMGB1, whereas the activation of the calciumregulating system as manifested by the elevated PTH aims at restoration of calcium homeostasis and thus have positive, i.e. cardioprotective consequences.
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Nigam A, Xu B, Spanheimer PM, Ganly I, Tuttle RM, Wong RJ, Shaha AR, Ghossein RA, Untch BR. Tumor Grade Predicts for Calcitonin Doubling Times and Disease-Specific Outcomes After Resection of Medullary Thyroid Carcinoma. Thyroid 2022; 32:1193-1200. [PMID: 35950622 PMCID: PMC9595606 DOI: 10.1089/thy.2022.0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Tumor grade is a new validated prognostic factor for medullary thyroid cancer (MTC). Calcitonin doubling time can predict MTC recurrence. We aimed to describe the association of tumor grade with calcitonin doubling and its effect on disease-specific outcomes times after resection. Methods: A retrospective analysis of MTC patients who underwent resection at a single tertiary-care cancer center between 1986 and 2017 were evaluated. Tumors were designated as high-grade MTC if two head and neck pathologists identified mitotic index ≥5 per 2 mm2, tumor necrosis, or a Ki67 proliferative index ≥5% within the tumor. Calcitonin doubling time was calculated using a validated calculator with at least three consecutive levels. Using Cox proportional hazards models, outcomes evaluated included locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Results: Among 117 patients, 95 were low grade and 22 high grade. Median follow-up was 70.2 months. High-grade patients demonstrated significantly faster calcitonin doubling times when compared with low-grade patients (8.51 ± 3.22 months vs. 38.42 ± 11.19 months; p < 0.001). In addition, most high-grade patients (66.7%) had calcitonin doubling times less than 1 year compared with fewer low-grade patients (1.0%; p < 0.001). High- and low-grade patients were further stratified by those who had calcitonin doubling times less than or greater than 2 years-a previously validated prognostic cutoff point. For patients with calcitonin doubling times less than 2 years, 70% were high grade, while 30% were low grade (p < 0.001). On multivariate analysis comparing grade and calcitonin doubling times, high-grade patients had significantly worse LRFS (hazards ratio [HR] 4.77 [confidence interval; CI 1.19-8.81]), DMFS (HR 7.25 [CI 2.36-22.28]), and OS (HR 6.04 [CI 1.85-19.72]; p < 0.05 for all), while calcitonin doubling times less than 2 years had worse DMFS (HR 7.22 [CI 1.05-49.75]). High-grade patients with calcitonin doubling times less than 2 years had associated worse LRFS and OS (both p < 0.05) compared with low-grade patients. Conclusions: The majority of high-grade MTC patients have calcitonin doubling times less than 2years. Close monitoring should be advocated for patients assessed to have high-grade tumors as they are at risk for poor disease-specific outcomes and structural recurrence.
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Affiliation(s)
- Aradhya Nigam
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Philip M. Spanheimer
- Department of Surgery and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R. Michael Tuttle
- Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J. Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashok R. Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald A. Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian R. Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Cvek M, Punda A, Brekalo M, Plosnić M, Barić A, Kaličanin D, Brčić L, Vuletić M, Gunjača I, Torlak Lovrić V, Škrabić V, Boraska Perica V. Presence or severity of Hashimoto's thyroiditis does not influence basal calcitonin levels: observations from CROHT biobank. J Endocrinol Invest 2022; 45:597-605. [PMID: 34617251 DOI: 10.1007/s40618-021-01685-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The influence of Hashimoto's thyroiditis (HT) on calcitonin (Ct) production is unresolved question. The aim of this study was to explore if basal Ct levels are influenced by the presence/severity of HT or correlated with clinical phenotypes of HT patients. METHODS We included 467 HT patients and 184 control participants, from Croatian Biobank of HT patients (CROHT), in this retrospective study. Calcitonin levels between HT patients and controls were compared using Mann-Whitney test. Ct levels between two subgroups of HT patients, divided by intake of levothyroxine (LT4) therapy, were additionally tested to take into account the illness severity. Spearman rank correlation test was used to analyze correlations between Ct levels and 14 relevant phenotypes. RESULTS We have not detected significant differences in median Ct levels between HT patients and controls (2.2 vs 2.35 pg/mL, respectively, P = 0.717) nor in-between two subgroups of HT patients (P = 0.347). We have not detected statistically significant correlations between Ct levels and clinical phenotypes, although we identified three weak nominal correlations: negative correlation of Ct with TgAb in all HT patients (r = - 0.1, P = 0.04); negative correlation of Ct with age in subgroup of HT patients without LT4 therapy (r = - 0.13, P = 0.04); positive correlation of Ct with BSA in subgroup of HT patients on LT4 therapy (r = 0.16, P = 0.042). CONCLUSION Our results suggest that HT patients of all disease stages preserve Ct production as healthy individuals and there is no need for Ct measurements in the absence of a nodule. Additional confirmation and clarification of observed nominal correlations are needed due to potential clinical relevance of TgAb and age-dependent Ct decrease in HT women.
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Affiliation(s)
- M Cvek
- Department of Nuclear Medicine, University Hospital of Split, Split, Croatia
| | - A Punda
- Department of Nuclear Medicine, University Hospital of Split, Split, Croatia
| | - M Brekalo
- Department of Nuclear Medicine, University Hospital of Split, Split, Croatia
| | - M Plosnić
- Department of Medical Biology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - A Barić
- Department of Nuclear Medicine, University Hospital of Split, Split, Croatia
| | - D Kaličanin
- Department of Medical Biology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - L Brčić
- Department of Medical Biology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - M Vuletić
- Department of Nuclear Medicine, University Hospital of Split, Split, Croatia
| | - I Gunjača
- Department of Medical Biology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - V Torlak Lovrić
- Department of Nuclear Medicine, University Hospital of Split, Split, Croatia
| | - V Škrabić
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | - V Boraska Perica
- Department of Medical Biology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia.
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Multiple Endocrine Neoplasia in Childhood: An Update on Diagnosis, Screening, Management and Treatment. ENDOCRINES 2022. [DOI: 10.3390/endocrines3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multiple endocrine neoplasia (MEN) is a group of heterogenous syndromes characterized by the occurrence of two or more endocrine gland tumors in a patient or related individuals in the same family. They are inherited in an autosomal dominant fashion and are highly penetrant. There are three types of MEN syndromes: MEN type 1 (MEN1), MEN type 2 (MEN2), and MEN type 4 (MEN4). MEN2 is further divided into MEN2A, MEN2B (formerly known MEN3), and familial medullary thyroid carcinoma (FMTC). Although MEN syndromes are rare, it is crucial to identify individuals at risk for potentially life-threatening neoplasias. This review article provides an update on each MEN syndrome, its genetics, diagnosis, and management in children.
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Eckelt F, Pfaeffle R, Kiess W, Kratzsch J. Calcitonin and complementary biomarkers in the diagnosis of hereditary medullary thyroid carcinoma in children and adolescents. J Pediatr Endocrinol Metab 2021; 34:1491-1504. [PMID: 34543539 DOI: 10.1515/jpem-2021-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Medullary thyroid carcinoma (MTC) is a rare malignancy that is effectively curable by surgery. Unlike in adults, hereditary MTC has a predominant role in children. A fast and safe diagnosis is important to assure the good prognosis for the patients. A major cornerstone is the assessment of biomarkers, but the interpretation must respect their pre-, post- and analytical features. Especially calcitonin (Ctn) is a challenging biomarker in daily laboratory diagnostics. However, Ctn is of particular relevance for the diagnostic in MTC. The American Thyroid Association recommends thyroidectomy if the upper reference range of Ctn is exceeded. Interestingly, age-dependent reference ranges for children and adolescents have become available only recently for Ctn assays. With this review, we aim to highlight the importance of a timely diagnosis of MTC in children and adolescents. CONTENT Recent developments in pediatric biochemical diagnostics of MTC were summarized. This includes guidance on interpretation of RET, Ctn, procalcitonin, carcinoembryonic antigen, carbohydrate antigen 19-9, and chromogranin A. SUMMARY Currently, Ctn is the most investigated biomarker in the diagnosis of MTC in children and adolescents. Other biomarkers as PCT suggest complementary evidence about pediatric MTC but their interpretation based largely on adult's data. A successful treatment of MTC requires, besides results of biomarkers, information about medical history, RET gene analysis and recent guideline knowledge. OUTLOOK More research is required to validate complementary biomarkers of Ctn in children. Additionally, the effect of different confounder on pediatric Ctn levels has to be further clarified.
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Affiliation(s)
- Felix Eckelt
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Roland Pfaeffle
- Department Woman and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Department Woman and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Juergen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
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van den Broek MFM, Rijks EBG, Nikkels PGJ, Wolters VM, van Es RJJ, van Santen HM, van Nesselrooij BPM, Vriens MR, van Leeuwaarde RS, Valk GD, Verrijn Stuart AA. Timely diagnosis of multiple endocrine neoplasia 2B by identification of intestinal ganglioneuromatosis: a case series. Endocrine 2021; 72:905-914. [PMID: 33474713 PMCID: PMC8159807 DOI: 10.1007/s12020-021-02607-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) in childhood is rare and has an unfavorable prognosis. To improve outcome, early diagnosis is essential. In patients with multiple endocrine neoplasia type 2B (MEN2B), MTC can occur already before the age of 1 year. Recognition of non-endocrine features of MEN2B may lead to timely diagnosis. PURPOSE To describe how early recognition of non-endocrine features can lead to a timely diagnosis of MEN2B as well as the effect of recognition of premonitory symptoms on prognosis. METHODS A retrospective case series from the University Medical Center Utrecht/Wilhelmina Children's Hospital, a Dutch national expertise center for MEN patients. All eight MEN2B patients in follow-up between 1976 and 2020 were included and medical records reviewed. RESULTS Intestinal ganglioneuromatosis (IGN) as the cause of gastrointestinal (GI) symptoms was detected in seven patients. In three of them within months after birth. This led to early diagnosis of MEN2B, which allowed subsequent curative thyroid surgery. On the contrary, a MEN2B diagnosis later in childhood-in three patients (also) triggered by oral neuromas/neurofibromas-led to recurrent, persistent, and/or progressive MTC in five patients. CONCLUSIONS Neonatal GI manifestations offer the most important window of opportunity for early detection of MEN2B. By accurate evaluation of rectal biopsies in patients with early onset severe constipation, IGN can be timely detected, while ruling out Hirschsprung's disease. MEN2B gene analysis should follow detection of IGN and-when confirmed-should prompt possibly still curative thyroid surgery.
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Affiliation(s)
| | - Ester B G Rijks
- Netherlands School of Public and Occupational Health (NSPOH), Utrecht, The Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Victorien M Wolters
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Princess Maxima Center, Utrecht, The Netherlands
| | - Bernadette P M van Nesselrooij
- Department of Medical Genetics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie A Verrijn Stuart
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Kartal Baykan E, Erdoğan M. Basal and pentagastrin-stimulated calcitonin cut-off values in diagnosis of preoperative medullary thyroid cancer. Turk J Med Sci 2021; 51:650-656. [PMID: 33128357 PMCID: PMC8203141 DOI: 10.3906/sag-2003-182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background/aim Medullary thyroid cancer (MTC) originates from parafollicular cells (C cell) and produces calcitonin (CT). Basal serum CT was used in the diagnosis and treatment of MTC. If basal CT level is 100 pg/mL or higher, it is likely to have MTC, but if basal CT level is below 10 pg/mL, the probability of developing thyroid disease is low. In cases with basal CT level between 10–100 pg/mL, pentagastrin-stimulated (PS) CT level is studied to evaluate MTC and C cell hyperplasia (CHH). This study aimed to determine cut-off value for basal and PS peak CT level for diagnosis of MTC. Materials and methods We retrospectively reviewed files of patients presented to endocrine outpatient clinic of Ege University, Medicine School, between 2010 and 2019; 176 patients with basal CT level of 10–100 pg/mL and patients with PS test were included to the study. Results The receiver operating characteristic curve (ROC) analysis was used to determine cut-off value for basal CT that can discriminate cases with MTC and those with nodular goiter. Cut-off value for basal CT was calculated as 46.5 pg/mL (specificity; 100 %, sensitivity; 74 %). In the ROC analysis for peak PS CT, cut-off value was calculated as 285 pg/mL (specificity:100 %; sensitivity:82 %). When peak CT level was > 290 pg/mL in PS test, both specificity and sensitivity for MTC were determined as 100 %. The PS peak CT level > 285 pg/mL was significant for MTC diagnosis while range of 117–274 pg/mL was significant for CHH. Conclusion In this study, cut-off value was calculated as 46.5 pg/mL for basal CT, whereas 285 pg/mL for PS peak CT in the diagnosis of preoperative MTC.
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Affiliation(s)
- Emine Kartal Baykan
- Department of Endocrinology and Metabolism, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Erdoğan
- Department of Endocrinology and Metabolism, Ege University Medical Faculty, İzmir, Turkey
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Song E, Jeon MJ, Yoo HJ, Bae SJ, Kim TY, Kim WB, Shong YK, Kim HK, Kim WG. Gender-Dependent Reference Range of Serum Calcitonin Levels in Healthy Korean Adults. Endocrinol Metab (Seoul) 2021; 36:365-373. [PMID: 33823567 PMCID: PMC8090475 DOI: 10.3803/enm.2020.939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Serum calcitonin measurement contains various clinical and methodological aspects. Its reference level is wide and unclear despite sensitive calcitonin kits are available. This study aimed to identify the specific reference range in the healthy Korean adults. METHODS Subjects were ≥20 years with available calcitonin (measured by a two-site immunoradiometric assay) data by a routine health checkup. Three groups were defined as all eligible subjects (group 1, n=10,566); subjects without self or family history of thyroid disease (group 2, n=5,152); and subjects without chronic kidney disease, autoimmune thyroid disease, medication of proton pump inhibitor/H2 blocker/steroid, or other malignancies (group 3, n=4,638). RESULTS This study included 6,341 male and 4,225 female subjects. Males had higher mean calcitonin than females (2.3 pg/mL vs. 1.9 pg/mL, P<0.001) in group 1. This gender difference remained similar in groups 2 and 3. Calcitonin according to age or body mass index was not significant in both genders. Higher calcitonin in smoking than nonsmoking men was observed but not in women. Sixty-nine subjects had calcitonin higher than the upper reference limit (10 pg/mL) and 64 of them had factors associated with hypercalcitoninemia besides medullary thyroid cancer. Our study suggests the reference intervals for men who were non, ex-, current smokers, and women (irrespective of smoking status) as <5.7, <7.1, <7.9, and <3.6 pg/mL, respectively. CONCLUSION Specific calcitonin reference range should be provided considering for sex and smoking status. Taking account for several factors known to induce hypercalcitoninemia can help interpret the gray zone of moderately elevated calcitonin.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine,
Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine,
Korea
| | - Sung Jin Bae
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hong-Kyu Kim
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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12
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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13
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Moreira LM, Takawale A, Hulsurkar M, Menassa DA, Antanaviciute A, Lahiri SK, Mehta N, Evans N, Psarros C, Robinson P, Sparrow AJ, Gillis MA, Ashley N, Naud P, Barallobre-Barreiro J, Theofilatos K, Lee A, Norris M, Clarke MV, Russell PK, Casadei B, Bhattacharya S, Zajac JD, Davey RA, Sirois M, Mead A, Simmons A, Mayr M, Sayeed R, Krasopoulos G, Redwood C, Channon KM, Tardif JC, Wehrens XHT, Nattel S, Reilly S. Paracrine signalling by cardiac calcitonin controls atrial fibrogenesis and arrhythmia. Nature 2020; 587:460-465. [PMID: 33149301 DOI: 10.1038/s41586-020-2890-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/13/2020] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation, the most common cardiac arrhythmia, is an important contributor to mortality and morbidity, and particularly to the risk of stroke in humans1. Atrial-tissue fibrosis is a central pathophysiological feature of atrial fibrillation that also hampers its treatment; the underlying molecular mechanisms are poorly understood and warrant investigation given the inadequacy of present therapies2. Here we show that calcitonin, a hormone product of the thyroid gland involved in bone metabolism3, is also produced by atrial cardiomyocytes in substantial quantities and acts as a paracrine signal that affects neighbouring collagen-producing fibroblasts to control their proliferation and secretion of extracellular matrix proteins. Global disruption of calcitonin receptor signalling in mice causes atrial fibrosis and increases susceptibility to atrial fibrillation. In mice in which liver kinase B1 is knocked down specifically in the atria, atrial-specific knockdown of calcitonin promotes atrial fibrosis and increases and prolongs spontaneous episodes of atrial fibrillation, whereas atrial-specific overexpression of calcitonin prevents both atrial fibrosis and fibrillation. Human patients with persistent atrial fibrillation show sixfold lower levels of myocardial calcitonin compared to control individuals with normal heart rhythm, with loss of calcitonin receptors in the fibroblast membrane. Although transcriptome analysis of human atrial fibroblasts reveals little change after exposure to calcitonin, proteomic analysis shows extensive alterations in extracellular matrix proteins and pathways related to fibrogenesis, infection and immune responses, and transcriptional regulation. Strategies to restore disrupted myocardial calcitonin signalling thus may offer therapeutic avenues for patients with atrial fibrillation.
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Affiliation(s)
- Lucia M Moreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Abhijit Takawale
- Research Centre, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Mohit Hulsurkar
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - David A Menassa
- Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Biological Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK
| | - Agne Antanaviciute
- Medical Research Council (MRC) Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Satadru K Lahiri
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Neelam Mehta
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Neil Evans
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Constantinos Psarros
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Paul Robinson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Alexander J Sparrow
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Marc-Antoine Gillis
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Neil Ashley
- Single-Cell Genomics Facility, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Patrice Naud
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Angela Lee
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mary Norris
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Michele V Clarke
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Patricia K Russell
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Shoumo Bhattacharya
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jeffrey D Zajac
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Rachel A Davey
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Martin Sirois
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Adam Mead
- Medical Research Council (MRC) Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Alison Simmons
- Medical Research Council (MRC) Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Manuel Mayr
- King's British Heart Foundation Centre, King's College London, London, UK
| | - Rana Sayeed
- Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - George Krasopoulos
- Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - Charles Redwood
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jean-Claude Tardif
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Stanley Nattel
- Research Centre, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- IHU LIRYC, Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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14
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Eckelt F, Vogel M, Geserick M, Kirsten T, Bae YJ, Baber R, Schaab M, Thiery J, Pfaeffle R, Raue F, Kiess W, Kratzsch J. Calcitonin measurement in pediatrics: reference ranges are gender-dependent, validation in medullary thyroid cancer and thyroid diseases. Clin Chem Lab Med 2020; 57:1242-1250. [PMID: 30794525 DOI: 10.1515/cclm-2018-1186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is only limited information on serum reference ranges of calcitonin (CT) in infants, children and adolescents. This gap hampers valid diagnostics in patients with multiple endocrine neoplasia type 2 (MEN 2) and planned prophylactic thyroidectomy. In addition, age-dependent reference ranges for CT are necessary to define a cure in medullary thyroid carcinoma (MTC). We asked whether the reference ranges for CT levels were age- and gender-dependent in the serum of a pediatric cohort. METHODS A total of 6090 serum samples of 2639 subjects of the LIFE-Child cohort aged between 1 month and 17.9 years were analyzed by the CT electrochemiluminescence immunoassay (ECLIA). Reference intervals were estimated using the LMS method. For clinical validation the serum of 28 patients (61 samples) with MEN 2 and 106 patients (136 samples) with thyroid diseases were analyzed. RESULTS CT levels showed a clear age- and gender-dependence with significantly higher values in boys (p<0.01). An accelerated decline of CT levels from newborn to children at the age of 4 and 5 years was observed for both sexes. A cure for MTC was demonstrated in 71% of MEN 2 patients after thyroidectomy, whereas 5 patients remained suspicious for micrometastasis or relapse. Only 1.5% of our patients with thyroid diseases revealed increased CT levels. CONCLUSIONS This is the largest study to establish novel pediatric reference ranges from the CT values of healthy subjects. It allows a precise laboratory monitoring of CT in pediatric patients with MEN 2. Thyroid diseases did not have a relevant influence on CT levels in our pediatric cohort.
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Affiliation(s)
- Felix Eckelt
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
| | - Mandy Vogel
- LIFE-Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Mandy Geserick
- LIFE-Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Toralf Kirsten
- LIFE-Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Yoon Ju Bae
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
| | - Ronny Baber
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany.,LIFE-Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Michael Schaab
- MVZ Laboratory Reising-Ackermann MD and Colleagues, Leipzig, Germany
| | - Joachim Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
| | - Roland Pfaeffle
- Hospital for Children and Adolescents, Centre for Paediatric Research, Department of Women and Child Health, University Hospital of Leipzig, Leipzig, Germany
| | - Friedhelm Raue
- Endocrine Practice, Molecular Genetic Laboratory, Heidelberg, Germany
| | - Wieland Kiess
- LIFE-Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Hospital for Children and Adolescents, Centre for Paediatric Research, Department of Women and Child Health, University Hospital of Leipzig, Leipzig, Germany
| | - Juergen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany
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15
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Omer W, El-Kemary MA, Elsaady MM, Abou-Omar MN, Youssef AO, Sayqal AA, Gouda AA, Attia MS. Highly Efficient Gold Nano-Flower Optical Biosensor Doped in a Sol-Gel/PEG Matrix for the Determination of a Calcitonin Biomarker in Different Serum Samples. ACS OMEGA 2020; 5:5629-5637. [PMID: 32226838 PMCID: PMC7097903 DOI: 10.1021/acsomega.9b02833] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/19/2020] [Indexed: 05/08/2023]
Abstract
We developed a novel, simple, sensitive, accurate, and precise method for the determination of calcitonin in different serum samples with medullar thyroid carcinoma. The designed flower-like thin film gold nanoparticles doped in a sol-gel/polyethylene glycol mold are used as an optical biosensor for the efficient determination of calcitonin. The sensor was characterized by transmission electron microscopy, scanning electron microscopy, X-ray diffraction, energy-dispersive X-ray microanalysis, and Fourier-transform infrared spectroscopy. The efficiency of the considered bio-sensor is done using the quencher calcitonin of the emission band at 360 nm of biomarker obtained at λex = 333 nm in acetonitrile solvent. The sensing mechanism was based on fluorescence resonance energy transfer. The remarkable quenching of the fluorescence intensity at 360 nm of optical sensor by various concentrations of calcitonin was successfully used as an optical biosensor for the assessment of calcitonin for different serum samples of patients with medullar thyroid carcinoma. The calibration plot was prepared for the concentration range 0.01-1000 pg/mL of calcitonin with a correlation coefficient of 0.99 and a detection limit of 0.707 pg/mL. The suggested method augments the sensitivity of calcitonin as a useful biomarker for the early diagnosis of medullar thyroid carcinoma. This method is considered as a gateway for the construction of a new prototype for the follow-up of thyroid cancer in the spinal cord during and after treatment.
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Affiliation(s)
- Walaa
E. Omer
- Institute
of Nanoscience and Nanotechnology, Kafrelsheikh
University, 33516 Kafr El-Shaikh, Egypt
| | - Maged A. El-Kemary
- Institute
of Nanoscience and Nanotechnology, Kafrelsheikh
University, 33516 Kafr El-Shaikh, Egypt
| | - Mostafa M. Elsaady
- Department
of Chemistry, Faculty of Science, Ain Shams
University, 11566 Cairo, Egypt
| | - Mona N. Abou-Omar
- Department
of Chemistry, Faculty of Women for Arts, Science and Education, Ain Shams University, 11566 Cairo, Egypt
| | - Ahmed O. Youssef
- Department
of Chemistry, Faculty of Science, Ain Shams
University, 11566 Cairo, Egypt
| | - Ali A. Sayqal
- Chemistry
Department, Faculty of Applied Sciences, Umm Al-Qura University, 24231 Makkah, Saudi Arabia
| | - Ayman A. Gouda
- Faculty
of Public Health and Health Informatics, Umm Al-Qura University, 24231 Makkah, Saudi Arabia
| | - Mohamed S. Attia
- Department
of Chemistry, Faculty of Science, Ain Shams
University, 11566 Cairo, Egypt
- E-mail: , . Phone: +(202)
1229867311, +(202) 1060818922
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16
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Costante G, Meringolo D. Calcitonin as a biomarker of C cell disease: recent achievements and current challenges. Endocrine 2020; 67:273-280. [PMID: 31925733 DOI: 10.1007/s12020-019-02183-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/29/2019] [Indexed: 12/19/2022]
Abstract
The neoplastic proliferation of parafollicular thyroid cells (C cells) may occur as either medullary thyroid carcinoma (MTC) or C cell hyperplasia (CCH) and is generically defined C cell disease. Since Calcitonin (CT) expression is fully maintained in neoplastic C cells, this hormone represents a sensitive marker for neoplasia of C cell derivation such as CCH and MTC. Serum CT levels display a high prognostic value and accurate estimation of tumor burden, allowing early detection of persistence/relapse and representing a reliable marker of response to treatment. Indeed, elevated CT levels can occur in other non-C cell-related conditions (i.e., other malignancies, systemic diseases, and pharmacological treatments). Moreover, some de-differentiated, more aggressive MTCs may present disproportionately low-circulating CT levels, as compared with tumor burden. During the postsurgical follow-up of MTC patients, CT levels usually parallel tumor progression and their increase unambiguously announces persistence/relapse. In this respect, CT Doubling Time (DT) has been proposed as prognostic factor of potential use for the identification of more aggressive MTCs. The present review will summarize the novel achievements on the clinical suitability of CT as a biomarker in clinical oncology and will point the attention to the most recent results concerning the usefulness and the possible drawbacks of circulating CT as a surrogate marker for the identification of rapidly progressing MTC patients, such as those candidate to targeted therapies. The emerging role of circulating CT as a parameter of response to local and systemic therapies will also be illustrated.
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Affiliation(s)
- Giuseppe Costante
- Endocrinology Clinic, Department of Medicine - Institut Jules Bordet Comprehensive Cancer Center, Université Libre de Bruxelles, Bruxelles, Belgium.
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17
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A ratiometric electrochemiluminescent immunoassay for calcitonin by using N-(aminobutyl)-N-(ethylisoluminol) and graphite-like carbon nitride. Mikrochim Acta 2019; 186:771. [DOI: 10.1007/s00604-019-3934-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/12/2019] [Indexed: 02/07/2023]
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18
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Castellano E, Attanasio R, Latina A, Gennaro M, Boriano A, Borretta G. INCREASED SERUM CALCITONIN IN SPORADIC PRIMARY HYPERPARATHYROIDISM IS AN UNCOMMON OCCURRENCE. Endocr Pract 2019; 25:1279-1285. [PMID: 31412223 DOI: 10.4158/ep-2019-0246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To evaluate calcitonin (CT) levels in sporadic primary hyperparathyroidism (PHPT), which has to date rarely been considered. Methods: We evaluated serum CT levels in 290 consecutive patients with sporadic PHPT at diagnosis. Results: Mild elevations in CT levels (hyperCT) were found in 25 patients (8.6%), with no correlation among the demographic, clinical, and biochemical findings. In addition, no differences were found between patients with and without hyperCT. Follow-up data were available for 19/25 patients, but CT values were only available for 10. CT normalized in all surgically cured patients regardless of the extent of the surgery (parathyroidectomy [PTX] only in 8 and associated with partial or total thyroidectomy for benign nodular goiters in 7). Conclusion: hyperCT is an uncommon feature of sporadic PHPT and not related to biochemical or clinical features of the disease. In addition, hyperCT is reversible after PTX, regardless of whether concomitant thyroidectomies have been conducted. Abbreviations: CT = calcitonin; eGFR = estimated glomerular filtration rate; hyperCT = hypercalcitoninemia; MEN = multiple endocrine neoplasm; MTC = medullary thyroid carcinoma; PHPT = primary hyperparathyroidism; PPI = proton pump inhibitor; PTH = parathyroid hormone; PTX = parathyroidectomy.
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19
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Matsushita R, Nagasaki K, Ayabe T, Miyoshi Y, Kinjo S, Haruna H, Ihara K, Hasegawa T, Ida S, Ozono K, Minamitani K. Present status of prophylactic thyroidectomy in pediatric multiple endocrine neoplasia 2: a nationwide survey in Japan 1997-2017. J Pediatr Endocrinol Metab 2019; 32:585-595. [PMID: 31150358 DOI: 10.1515/jpem-2018-0444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/08/2019] [Indexed: 01/02/2023]
Abstract
Background In Japan, prophylactic thyroidectomy involves out-of-pocket expense. The American Thyroid Association (ATA) recommends prophylactic thyroidectomy for medullary thyroid carcinoma (MTC) during early childhood in patients with multiple endocrine neoplasia type 2 (MEN2). The ATA reports a high frequency of postoperative complications in childhood, which also influenced the delay of prophylactic thyroidectomy in Japan. Methods This retrospective study of multiple medical centers in Japan included individuals aged <20 years diagnosed with germline RET mutations between 1997 and 2017. The onset and onset possibility were defined based on confirmed lesions or calcitonin levels. The definition of risk and prophylactic thyroidectomy were based on the ATA 2015 revised guideline. Results Twenty-one patients with MEN2 were enrolled (highest risk, n = 5; high risk, n = 5; and moderate risk, n = 11). The cumulative incidence of the onset/onset possibility reached 50% at 5 and 8 years and 100% at 9 years and 17 years in high- and moderate-risk patients, respectively. Of 7 patients with MEN2A, 71% underwent prophylactic thyroidectomy. Only one 5-year-old patient (C634Y) had increased serum calcitonin level after prophylactic thyroidectomy in the MEN2A group. The only permanent complication, which did not occur in patients who underwent total thyroidectomy alone, was hypoparathyroidism (33% of patients). This permanent complication occurred with clinically developed MTC. No permanent postoperative complications occurred in patients aged 5-6 years. Conclusions Prophylactic thyroidectomy reduces recurrence and postoperative complications in pediatric patients with MEN2. Early thyroidectomy based on only calcitonin level could possibly reduce thyroidectomy delay.
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Affiliation(s)
- Rie Matsushita
- Division of Pediatrics, Kikugawa General Hospital, Shizuoka, Japan.,Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadayuki Ayabe
- Japan Environment and Children's Study Medical Support Center, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Saori Kinjo
- Division of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan
| | - Hidenori Haruna
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Ihara
- Department of Pediatrics, Faculty of Medicine, Oita University, Oita, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Shinobu Ida
- Department of Gastroenterology and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan.,Pediatric Chronic Intestinal Pseudo-Obstruction (CIPO), Research Group for "Comprehensive Study and Seamless Guidelines" on Rare and Intractable Gastrointestinal Disease from Childhood, Supported by the Ministry of Health, Labor and Welfare of Japan, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kanshi Minamitani
- Department of Pediatrics, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-shi, Chiba 299-0111, Japan
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20
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Al-Kurd A, Gross DJ, Zangen D, Atlan K, Mazeh H, Grozinsky-Glasberg S. Bilateral Medullary Thyroid Carcinoma in a 3-Year-Old Female Patient with Multiple Endocrine Neoplasia 2A Syndrome Undergoing Prophylactic Thyroidectomy: Should Current Guidelines Be Revised? Eur Thyroid J 2018; 7:267-271. [PMID: 30374431 PMCID: PMC6198771 DOI: 10.1159/000489170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Multiple endocrine neoplasia (MEN) 2A is an autosomal dominant disorder that results from a mutation in the RET proto-oncogene on chromosome 10. Almost all of the affected patients develop medullary thyroid carcinoma (MTC). The American Thyroid Association recommends prophylactic thyroidectomy in MEN 2A pediatric patients, with the age of the recommended thyroidectomy varying according to the codon mutation present. OBJECTIVES This report questions the reliability of the currently placed guidelines and whether the age threshold for prophylactic thyroidectomy in patients with known codon 634 mutations should be lowered, in parallel with an earlier evaluation of calcitonin levels in the serum. METHODS We report the preoperative diagnosis as well as operative and postoperative course of a 3-year-old female patient with MEN 2A (codon 634 mutation) who underwent prophylactic thyroidectomy. The postoperative histopathologic findings are presented and discussed. RESULTS Despite the prophylactic nature of the operation, in parallel with a borderline calcitonin increase in the serum, bilateral MTC was discovered on pathology. CONCLUSION It is likely that the current guidelines should be revised to recommend calcitonin screening and prophylactic thyroidectomy at an earlier age for MEN 2A patients with known codon 634 mutations.
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Affiliation(s)
- Abbas Al-Kurd
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- *Abbas Al-Kurd, MD, Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, PO Box 24035, Jerusalem (Israel), E-Mail
| | - David J. Gross
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Zangen
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karine Atlan
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haggi Mazeh
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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21
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Xu N, Jian Y, Wang Y, Tian W. Evaluation of neutrophil-to-lymphocyte ratio and calcitonin concentration for predicting lymph node metastasis and distant metastasis in patients with medullary thyroid cancer. Mol Clin Oncol 2018; 9:629-634. [PMID: 30546892 DOI: 10.3892/mco.2018.1727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/14/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to investigate potential predictive factors of lymph node metastasis (LNM) and distant metastasis (DM) of medullary thyroid cancer (MTC). A total of 61 patients newly diagnosed with MTC at the General Hospital of the Chinese People's Liberation Army between January 2001 and January 2016 were enrolled and divided into two groups according to the results of preoperative examinations and surgical histopathology as follows: Group NM (without metastases), and group M (with metastases). Univariate logistic regression analysis demonstrated that sex, tumor size, preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR), and concentration of carcinoembryonic antigen (CEA) and calcitonin (Ctn), were significantly associated with LNM and DM. The multivariate analysis revealed that a Ctn concentration of >500 pg/ml [odds ratio (OR)=21.422; 95% confidence interval (CI): 2.611-175.731] and the NLR (OR=5.918; 95% CI: 1.147-30.541) were positively correlated with LNM and DM. The optimal cut-off value of the NLR for predicting LNM and DM obtained from receiver operating characteristic curve analysis was 1.784 (sensitivity 68.3% and specificity 80%), and the area under the curve was 0.717. In conclusion, the findings of the present study strongly suggest that inflammation and immune activation of MTC cells promote LNM and DM, and that higher values of NLR and Ctn concentration confer a high risk of metastasis.
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Affiliation(s)
- Nizhen Xu
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yanbing Jian
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yaxi Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
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22
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Wasserman JD, Tomlinson GE, Druker H, Kamihara J, Kohlmann WK, Kratz CP, Nathanson KL, Pajtler KW, Parareda A, Rednam SP, States LJ, Villani A, Walsh MF, Zelley K, Schiffman JD. Multiple Endocrine Neoplasia and Hyperparathyroid-Jaw Tumor Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood. Clin Cancer Res 2018; 23:e123-e132. [PMID: 28674121 DOI: 10.1158/1078-0432.ccr-17-0548] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/02/2017] [Accepted: 05/16/2017] [Indexed: 12/19/2022]
Abstract
Children and adolescents who present with neuroendocrine tumors are at extremely high likelihood of having an underlying germline predisposition for the multiple endocrine neoplasia (MEN) syndromes, including MEN1, MEN2A and MEN2B, MEN4, and hyperparathyroid-jaw tumor (HPT-JT) syndromes. Each of these autosomal dominant syndromes results from a specific germline mutation in unique genes: MEN1 is due to pathogenic MEN1 variants (11q13), MEN2A and MEN2B are due to pathogenic RET variants (10q11.21), MEN4 is due to pathogenic CDKN1B variants (12p13.1), and the HPT-JT syndrome is due to pathogenic CDC73 variants (1q25). Although each of these genetic syndromes share the presence of neuroendocrine tumors, each syndrome has a slightly different tumor spectrum with specific surveillance recommendations based upon tumor penetrance, including the age and location for which specific tumor types most commonly present. Although the recommended surveillance strategies for each syndrome contain similar approaches, important differences do exist among them. Therefore, it is important for caregivers of children and adolescents with these syndromes to become familiar with the unique diagnostic criteria for each syndrome, and also to be aware of the specific tumor screening and prophylactic surgery recommendations for each syndrome. Clin Cancer Res; 23(13); e123-e32. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Gail E Tomlinson
- Department of Pediatrics, Division of Hematology and Oncology and Greehey Children's Cancer Research Institute, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Harriet Druker
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Junne Kamihara
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wendy K Kohlmann
- Huntsmann Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Katherine L Nathanson
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristian W Pajtler
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital, Heidelberg, Germany.,Division of Pediatric Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreu Parareda
- Division of Oncology, Predisposition and Survivorship Units, Sant Joan de Déu - Barcelona Children's Hospital, Barcelona, Spain
| | - Surya P Rednam
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anita Villani
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael F Walsh
- Departments of Medicine and Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kristin Zelley
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua D Schiffman
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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23
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Castinetti F, Moley J, Mulligan L, Waguespack SG. A comprehensive review on MEN2B. Endocr Relat Cancer 2018; 25:T29-T39. [PMID: 28698189 DOI: 10.1530/erc-17-0209] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022]
Abstract
MEN2B is a very rare autosomal dominant hereditary tumor syndrome associated with medullary thyroid carcinoma (MTC) in 100% cases, pheochromocytoma in 50% cases and multiple extra-endocrine features, many of which can be quite disabling. Only few data are available in the literature. The aim of this review is to try to give further insights into the natural history of the disease and to point out the missing evidence that would help clinicians optimize the management of such patients. MEN2B is mainly characterized by the early occurrence of MTC, which led the American Thyroid Association to recommend preventive thyroidectomy before the age of 1 year. However, as the majority of mutations are de novo, improved knowledge of the nonendocrine signs would help to lower the age of diagnosis and improve long-term outcomes. Future large-scale studies will be aimed at characterizing more in detail the main characteristics and outcomes of MEN2B.
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Affiliation(s)
- Frederic Castinetti
- Department of EndocrinologyAix Marseille University, CNRS UM 7286, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Jeffrey Moley
- Department of SurgeryWashington University School of Medicine, St Louis, Missouri, USA
| | - Lois Mulligan
- Division of Cancer Biology and GeneticsCancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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24
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Gao M, Ge M, Ji Q, Cheng R, Lu H, Guan H, Cui W, Gao L, Gao Z, Guo L, Guo Z, Huang T, Huang X, Lin Y, Liu Q, Ni X, Qin J, Ren L, Shan Z, Sun H, Wang X, Xu Z, Yu Y, Zhang B, Zhao D, Zheng Y, Zhu J, Zheng X, Chinese Association Of Thyroid Oncology Cato China Anti-Cancer Association. 2017 Chinese expert consensus on the clinical application of serum marker for thyroid cancer. Cancer Biol Med 2018; 15:468-477. [PMID: 30766757 PMCID: PMC6372917 DOI: 10.20892/j.issn.2095-3941.2018.0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ming Gao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Minghua Ge
- Department of Head and Neck, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qinghai Ji
- Department of Head and Neck Tumor, Fudan University Shanghai Cancer Center, Shanghai 200433, China
| | - Ruochuan Cheng
- Department of General Surgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Hankui Lu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200025, China
| | - Haixia Guan
- Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Wei Cui
- Department of Clinical Laboratory, Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, China
| | - Li Gao
- Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China
| | - Zairong Gao
- Department of Nuclear Medicine, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lin Guo
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai 200433, China
| | - Zhuming Guo
- Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Tao Huang
- Department of Thyroid and Breast, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaoming Huang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yansong Lin
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Qinjiang Liu
- Department of Head and Neck, Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Xin Ni
- Department of Head and Neck, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Jianwu Qin
- Department of Thyroid, Head and Neck, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Li Ren
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhongyan Shan
- Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Hui Sun
- Department of Thyroid, Sino Japanese Union Hospital of Jilin University, Changchun 130033, China
| | - Xudong Wang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhengang Xu
- Department of Head and Neck, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Yang Yu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Bin Zhang
- Department of Head and Neck, Peking Union Medical College Hospital, Beijing 100730, China
| | - Daiwei Zhao
- Department of General Surgery, The Second Affiliated Hospital of Guizhou Medical University, Kaili 556099, China
| | - Ying Zheng
- Department of Head and Neck, Jilin Tumor Hospital, Changchun 130012, China
| | - Jingqiang Zhu
- Department of Thyroid and Breast, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610047, China
| | - Xiangqian Zheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Chinese Association Of Thyroid Oncology Cato China Anti-Cancer Association
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Head and Neck, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Department of Head and Neck Tumor, Fudan University Shanghai Cancer Center, Shanghai 200433, China.,Department of General Surgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.,Department of Nuclear Medicine, The Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200025, China.,Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China.,Department of Clinical Laboratory, Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, China.,Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China.,Department of Nuclear Medicine, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai 200433, China.,Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Thyroid and Breast, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing 100730, China.,Department of Head and Neck, Gansu Provincial Cancer Hospital, Lanzhou 730050, China.,Department of Head and Neck, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.,Department of Thyroid, Head and Neck, Henan Cancer Hospital, Zhengzhou 450008, China.,Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Thyroid, Sino Japanese Union Hospital of Jilin University, Changchun 130033, China.,Department of Head and Neck, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China.,Department of Head and Neck, Peking Union Medical College Hospital, Beijing 100730, China.,Department of General Surgery, The Second Affiliated Hospital of Guizhou Medical University, Kaili 556099, China.,Department of Head and Neck, Jilin Tumor Hospital, Changchun 130012, China.,Department of Thyroid and Breast, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610047, China
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25
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Abstract
This article summarizes the main principles for the appropriate use of laboratory testing in the diagnosis and management of thyroid disorders, as well as controversies that have arisen in association with some of these biochemical tests. To place a test in perspective, its sensitivity and accuracy should be taken into account. Ordering the correct laboratory tests facilitates the early diagnosis of a thyroid disorder and allows for timely and appropriate treatment. This article focuses on a comprehensive update regarding thyroid-stimulating hormone, thyroxine/triiodothyronine, thyroid autoantibodies, thyroglobulin, and calcitonin. Clinical uses of these biochemical tests are outlined.
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Affiliation(s)
- Nazanene H Esfandiari
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms Lobby C, Suite 1300, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms Lobby G, Room 1649, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA.
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26
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Kahaly GJ, Algeciras-Schimnich A, Davis TE, Diana T, Feldkamp J, Karger S, König J, Lupo MA, Raue F, Ringel MD, Sipos JA, Kratzsch J. United States and European Multicenter Prospective Study for the Analytical Performance and Clinical Validation of a Novel Sensitive Fully Automated Immunoassay for Calcitonin. Clin Chem 2017; 63:1489-1496. [DOI: 10.1373/clinchem.2016.270009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/10/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The objective of this study is the validation and proof of clinical relevance of a novel electrochemiluminescence immunoassay (ECLIA) for the determination of serum calcitonin (CT) in patients with medullary thyroid carcinoma (MTC) and in different diseases of the thyroid and of calcium homeostasis.
METHODS
This was a multicenter prospective study on basal serum CT concentrations performed in 9 US and European referral institutions. In addition, stimulated CT concentrations were measured in 50 healthy volunteers after intravenous calcium administration (2.5 mg/kg bodyweight).
RESULTS
In total, 1929 patients and healthy controls were included. Limits of blank, detection, and quantification for the ECLIA were 0.3, 0.5, and 1 ng/L, respectively. Highest intra- and interassay coefficients of variation were 7.4% (CT concentration, 0.8 ng/L) and 7.0% (1.1 ng/L), respectively. Medians (interval) of serum CT concentrations in 783 healthy controls were 0.8 ng/L (<0.5–12.7) and 3 ng/L (<0.5–18) for females and males, respectively (97.5th percentile, 6.8 and 11.6 ng/L, respectively). Diagnostic sensitivity and specificity were 100%/97.1% and 96.2%/96.4%, for female/males, respectively. Patients (male/female) with primary hyperparathyroidism, renal failure, and neuroendocrine tumors showed CT concentrations >97.5th percentile in 33%/4.7%, 18.5%/10%, and 8.3%/12%, females/males, respectively. Peak serum CT concentrations were reached 2 min after calcium administration (161.7 and 111.8 ng/L in males and females, respectively; P < 0.001).
CONCLUSIONS
Excellent analytical performance, low interindividual variability, and low impact of confounders for increased CT concentrations in non-MTC patients indicate that the investigated assay has appropriate clinical utility. Calcium-stimulated CT results suggest good test applicability owing to low interindividual variability.
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Affiliation(s)
- George J Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | - Tanja Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | - Stefan Karger
- Clinic for Endocrinology and Nephrology, Leipzig University, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, JGU Medical Center, Mainz, Germany
| | - Mark A Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, FL
| | | | - Matthew D Ringel
- The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, OH
| | - Jennifer A Sipos
- The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, OH
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27
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Affiliation(s)
- Christine M Chan
- Section of Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Jonathan Young
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Jeremy Prager
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Sharon Travers
- Section of Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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28
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Schmidt A, Woedtke TV, Stenzel J, Lindner T, Polei S, Vollmar B, Bekeschus S. One Year Follow-Up Risk Assessment in SKH-1 Mice and Wounds Treated with an Argon Plasma Jet. Int J Mol Sci 2017; 18:E868. [PMID: 28422070 PMCID: PMC5412449 DOI: 10.3390/ijms18040868] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 12/25/2022] Open
Abstract
Multiple evidence in animal models and in humans suggest a beneficial role of cold physical plasma in wound treatment. Yet, risk assessment studies are important to further foster therapeutic advancement and acceptance of cold plasma in clinics. Accordingly, we investigated the longterm side effects of repetitive plasma treatment over 14 consecutive days in a rodent full-thickness ear wound model. Subsequently, animals were housed for 350 days and sacrificed thereafter. In blood, systemic changes of the proinflammatory cytokines interleukin 1β and tumor necrosis factor α were absent. Similarly, tumor marker levels of α-fetoprotein and calcitonin remained unchanged. Using quantitative PCR, the expression levels of several cytokines and tumor markers in liver, lung, and skin were found to be similar in the control and treatment group as well. Likewise, histological and immunohistochemical analysis failed to detect abnormal morphological changes and the presence of tumor markers such as carcinoembryonic antigen, α-fetoprotein, or the neighbor of Punc11. Absence of neoplastic lesions was confirmed by non-invasive imaging methods such as anatomical magnetic resonance imaging and positron emission tomography-computed tomography. Our results suggest that the beneficial effects of cold plasma in wound healing come without apparent side effects including tumor formation or chronic inflammation.
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Affiliation(s)
- Anke Schmidt
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), Departments of Plasma Life Science and ZIK Plasmatis, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany.
| | - Thomas von Woedtke
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), Departments of Plasma Life Science and ZIK Plasmatis, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany.
- Department of Hygiene and Environmental Medicine, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Jan Stenzel
- Core Facility Multimodal Small Animal Imaging, 18057 Rostock, Germany.
| | - Tobias Lindner
- Core Facility Multimodal Small Animal Imaging, 18057 Rostock, Germany.
| | - Stefan Polei
- Core Facility Multimodal Small Animal Imaging, 18057 Rostock, Germany.
| | - Brigitte Vollmar
- Institute for Experimental Surgery, Rostock University Medical Center, Schillingallee 69a, 18057 Rostock, Germany.
| | - Sander Bekeschus
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), Departments of Plasma Life Science and ZIK Plasmatis, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany.
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29
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Censi S, Cavedon E, Fernando SW, Barollo S, Bertazza L, Zambonin L, Zaninotto M, Faggian D, Plebani M, Mian C. Calcitonin measurement and immunoassay interference: a case report and literature review. Clin Chem Lab Med 2017; 54:1861-1870. [PMID: 27166721 DOI: 10.1515/cclm-2015-1161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/13/2016] [Indexed: 02/03/2023]
Abstract
Calcitonin (CT) is currently the most sensitive serological marker of C-cell disease [medullary thyroid carcinoma (MTC) and C-cell hyperplasia]. Starting with a report on a case that occurred at our institution, this review focuses on trying to explain the reasons behind the poor specificity and sensitivity of the various CT immunoassays. A 15-year-old patient was referred to our institution in May 2014 for moderately elevated CT levels. Thyroid ultrasonography (US) documented a colloidal goiter. Secondary causes of the hypercalcitoninemia (hyperCT) were ruled out. The mismatch between the clinical picture and the laboratory results prompted us to search for other reasons for the patient's high CT levels, so we applied the heterophilic blocking tube (HBT) procedure to the patient's sera before the CT assay. Using this pretreatment step, his serum CT concentration dropped to <1 ng/L, as measured at the same laboratory. Measuring plasma CT has an important role in screening for C-cell disease, but moderately elevated serum CT levels need to be placed in their clinical context, bearing in mind all the secondary causes of C-cell hyperplasia and the possibility of laboratory interference, before exposing patients to the risks and costs of further tests.
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30
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Opsahl EM, Brauckhoff M, Schlichting E, Helset K, Svartberg J, Brauckhoff K, Mæhle L, Engebretsen LF, Sigstad E, Grøholt KK, Akslen LA, Jørgensen LH, Varhaug JE, Bjøro T. A Nationwide Study of Multiple Endocrine Neoplasia Type 2A in Norway: Predictive and Prognostic Factors for the Clinical Course of Medullary Thyroid Carcinoma. Thyroid 2016; 26:1225-38. [PMID: 27400880 DOI: 10.1089/thy.2015.0673] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome caused by activating germline mutations in the RET (REarranged during Transfection) proto-oncogene. MEN 2A has a strong (>95%) and age-dependent (5-25 years) clinical penetrance of medullary thyroid carcinoma (MTC). Several major studies have analyzed the predictive and prognostic factors for MEN 2A to find indicators that predict the optimal timing of prophylactic thyroidectomy. The aims of this study were to describe all known RET positive MEN 2A patients diagnosed in Norway and to evaluate the clinical course of MTC, as well as its predictive and prognostic factors. METHODS This nationwide retrospective cohort study included data for 65 (14 index and 51 screening patients) out of a total of 67 MEN 2A patients with the RET gene mutation who were diagnosed in Norway since 1974. Data were collected by reviewing patient files. The variables analyzed were genotype, phenotype, preoperative basal calcitonin, age at thyroid surgery, central lymph node dissection and nodal status at primary surgery, number of surgical procedures, and biochemical cure. Of the 65 patients, 60 had undergone thyroid surgery. The median follow-up period was 9.9 years. The patients were divided into pre-RET-and RET-era, which included patients who had thyroid surgery before January 1, 1994, and after, respectively. RESULTS In index and screening patients, MTC was found, respectively, in 100% and 45% of cases, central lymph node dissection at primary surgery was done for 64% and 52% of patients, and the median total number of surgical procedures was two (range 1-6) and one (range 1-4). At primary surgery, all patients (n = 13) with lymph node metastases had preoperative basal calcitonin levels ≥68 pg/mL, and all patients (n = 17) without central lymph node dissection and preoperative basal calcitonin <40 pg/mL were biochemically cured. Multivariate analysis showed that preoperative basal calcitonin was a significant predictive factor for MTC superior to age at thyroid surgery when analyzing the entire period (p = 0.009) and the RET-era separately (p = 0.021). Prognostic factors for biochemical cure were preoperative basal calcitonin, central lymph node dissection, and nodal status at primary surgery (p = 0.037, p = 0.002, and p = 0.005) when analyzing the entire period, but only nodal status at primary surgery when the RET-era was considered separately (p = 0.006). CONCLUSIONS Preoperative basal calcitonin alone can serve as an indicator for optimal timing and the extent of thyroid surgery for MEN 2A patients that could be considered safe. The results are consistent with previously reported data.
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Affiliation(s)
- Else Marie Opsahl
- 1 Department of Oncology, Section for Breast and Endocrine Surgery, Oslo University Hospital , Oslo, Norway
- 2 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
| | - Michael Brauckhoff
- 3 Department of Breast and Endocrine Surgery, Haukeland University Hospital , Bergen, Norway
- 4 Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Ellen Schlichting
- 1 Department of Oncology, Section for Breast and Endocrine Surgery, Oslo University Hospital , Oslo, Norway
| | - Kristin Helset
- 5 Department of Breast and Endocrine Surgery, St. Olavs University Hospital , Trondheim, Norway
| | - Johan Svartberg
- 6 Division of Internal Medicine, University Hospital of North Norway , Tromsø, Norway
- 7 Institute of Clinical Medicine, UIT, The Arctic University of Norway , Tromsø, Norway
| | - Katrin Brauckhoff
- 3 Department of Breast and Endocrine Surgery, Haukeland University Hospital , Bergen, Norway
| | - Lovise Mæhle
- 8 Department of Medical Genetics, Oslo University Hospital , Oslo, Norway
| | | | - Eva Sigstad
- 10 Department of Pathology, Oslo University Hospital , Oslo, Norway
| | | | - Lars Andreas Akslen
- 11 Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen , Bergen, Norway
- 12 Department of Pathology, Haukeland University Hospital , Bergen, Norway
| | | | - Jan Erik Varhaug
- 3 Department of Breast and Endocrine Surgery, Haukeland University Hospital , Bergen, Norway
- 4 Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Trine Bjøro
- 2 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
- 14 Department of Medical Biochemistry, Oslo University Hospital , Oslo, Norway
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31
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Coan KE, Wang TS. Initial surgical management of medullary thyroid cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije-2015-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Medullary thyroid cancer (MTC) accounts for 5–10% of thyroid cancer. The majority, 75–80%, of MTC are sporadic with the remainder being hereditary secondary to a mutation in the RET proto-oncogene. Hereditary MTC may be isolated as in familial medullary thyroid cancer or associated with multiple endocrine neoplasia syndrome types 2A and 2B. The primary treatment modality for sporadic MTC is total thyroidectomy and central compartment neck dissection; consideration of lateral neck dissection should be based on preoperative imaging findings. The timing of prophylactic thyroidectomy is dependent on the specific RET codon mutation.
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Affiliation(s)
- Kathryn E Coan
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tracy S Wang
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Kloos RT, Monroe RJ, Traweek ST, Lanman RB, Kennedy GC. A Genomic Alternative to Identify Medullary Thyroid Cancer Preoperatively in Thyroid Nodules with Indeterminate Cytology. Thyroid 2016; 26:785-93. [PMID: 26992356 PMCID: PMC4913490 DOI: 10.1089/thy.2016.0001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of calcitonin screening for the rare medullary thyroid cancer (MTC) is controversial due to questions of efficacy, accuracy, and cost-effectiveness. This study reports the results of a large prospective validation using a machine-trained algorithm (MTC Classifier) to preoperatively identify MTC in fine-needle aspiration biopsies in lieu of calcitonin measurements. METHODS Cytology analysis on a prospective consecutive series of 50,430 thyroid nodule biopsies yielded a total of 7815 indeterminate (Bethesda categories III/IV) cases, which were tested with the MTC classifier. A prospective, consecutively submitted series of 2673 Bethesda III-VI cases with cytology determined locally was also evaluated. RNA was isolated and tested for the MTC Classifier using microarrays. RESULTS Forty-three cases were positive by the MTC Classifier among 10,488 tested nodules (0.4%), consistent with the low prevalence of MTC. Of these, all but one was histologically or biochemically confirmed as MTC, yielding a positive predictive value (PPV) of 98%. Of the positive cases, only 19 (44%) had been specifically suspected of MTC by cytology, highlighting the limitations of light microscopy to detect this disease. Three surgically confirmed MTC cases that were detected by the MTC Classifier had low basal serum calcitonin values, indicating these would have been missed by traditional calcitonin screening methods. A pooled analysis of three independent validation sets demonstrates high test sensitivity (97.9%), specificity (99.8%), PPV (97.9%), and negative predictive value (99.8%). CONCLUSIONS A clinical paradigm is proposed, whereby cytologically indeterminate thyroid nodules being tested for common malignancies using gene expression can be simultaneously tested for MTC using the same genomic assay at no added cost.
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Affiliation(s)
- Richard T. Kloos
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California
| | | | | | - Richard B. Lanman
- Department of Medical Affairs, Veracyte, Inc., South San Francisco, California
| | - Giulia C. Kennedy
- Department of Research and Development, Veracyte, Inc., South San Francisco, California
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33
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Cho YY, Jang HW, Jang JY, Kim TH, Choe JH, Kim JH, Kim JS, Kim SW, Chung JH. Clinical outcomes of patients with hypercalcitoninemia after initial treatment for medullary thyroid cancer and postoperative serum calcitonin cutoffs for predicting structural recurrence. Head Neck 2016; 38:1501-8. [PMID: 27062421 DOI: 10.1002/hed.24469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/30/2015] [Accepted: 02/19/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Persistent hypercalcitoninemia is reported in 40% to 60% of patients with medullary thyroid cancer (MTC) after initial therapy, but their clinical outcomes have not been clearly studied. We evaluated the outcomes of MTC with hypercalcitoninemia and assessed the cutoffs of postoperative serum calcitonin for predicting structural recurrence. METHODS A dynamic risk assessment system was used to categorize clinical outcomes in this retrospective study. Receiver operating characteristic (ROC) curve analysis was used to calculate the calcitonin cutoffs for predicting structural recurrence. RESULTS Among 120 patients operated on, 30 (25%) had persistent hypercalcitoninemia. Of that group, 18 (60%) had biochemical persistent disease and 11 (37%) developed structural identified disease, including 1 death (3%). Postoperative calcitonin <29 pg/mL predicted structural disease with 100% sensitivity, 90.5% specificity, and 100% negative predictive value. CONCLUSION One third of the patients with MTC with hypercalcitoninemia experienced structural recurrence, and postoperative basal serum calcitonin might be a simple tumor marker to predict structural recurrence. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1508, 2016.
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Affiliation(s)
- Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Young Jang
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Department of Surgery, Division of Breast and Endocrine Surgery, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Raue F, Frank-Raue K. Epidemiology and Clinical Presentation of Medullary Thyroid Carcinoma. Recent Results Cancer Res 2016; 204:61-90. [PMID: 26494384 DOI: 10.1007/978-3-319-22542-5_3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from the thyroid C cells producing mainly calcitonin (CTN) used as tumor marker. MTC occurs either sporadic (75%) or in a hereditary form (multiple endocrine neoplasia type 2, MEN2), due to germline mutations in the RET proto-oncogene. The discovery of an MTC in a patient has several diagnostic implications involving a specific strategy: preoperative evaluation of the tumor marker CTN and the extent of the disease, classification of MTC as sporadic or hereditary by DNA testing, and screening for associated endocrinopathies in hereditary MTC. Elevated CTN is a highly sensitive and specific tumor marker for diagnosis and follow-up of MTC. CTN is directly related to the tumor mass. In patients with nodular thyroid disease, diagnosis of MTC could be made by CTN determination as an indicator of tumor burden in conjunction with fine-needle aspiration. Patients with confirmed sporadic or hereditary MTC should have a total thyroidectomy and depending on the preoperative CTN value and the extent of disease additional dissection of the lymph nodes in the central and lateral neck compartment. In MEN 2 patients diagnosed by screening, the time of prophylactic thyroidectomy depends on RET mutation and CTN level.
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Affiliation(s)
- Friedhelm Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr. 21, 69120, Heidelberg, Germany.
| | - Karin Frank-Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr. 21, 69120, Heidelberg, Germany
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Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1306] [Impact Index Per Article: 145.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
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Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Martin TJ, Sims NA. Calcitonin physiology, saved by a lysophospholipid. J Bone Miner Res 2015; 30:212-5. [PMID: 25581311 DOI: 10.1002/jbmr.2449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/30/2014] [Accepted: 01/02/2015] [Indexed: 12/24/2022]
Affiliation(s)
- T John Martin
- St. Vincent's Institute of Medical Research and The University of Melbourne, Department of Medicine, St. Vincent's Hospital, Fitzroy, Australia
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Frank-Raue K, Raue F. Hereditary Medullary Thyroid Cancer Genotype-Phenotype Correlation. Recent Results Cancer Res 2015; 204:139-56. [PMID: 26494387 DOI: 10.1007/978-3-319-22542-5_6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
During the last two decades, there has been a marked expansion of our knowledge of both the basic and clinical aspects of multiple endocrine neoplasia type 2 (MEN2). There are two clinically distinct types of MEN2 syndrome, termed MEN2A and MEN2B. Within MEN2A, there are four variants: (i) classical MEN2A, represented by the uniform presence of MTC and the less frequent occurrence of pheochromocytoma, or primary hyperparathyroidism, or both; (ii) MEN2A with cutaneous lichen amyloidosis; (iii) MEN2A with Hirschsprung's disease; and (iv) familial medullary thyroid carcinoma (FMTC), i.e., families or individuals with only MTC. MEN2B is associated with MTC, pheochromocytoma, and mucosal neuromas. Hereditary MTC is caused by autosomal dominant gain of function mutations in the RET proto-oncogene. Specific RET mutations may suggest a predilection toward a particular phenotype and clinical course with a strong genotype-phenotype correlation. Based upon these genotype-phenotype correlations, RET mutations are now stratified into three risk levels, i.e., highest, high, and moderate risk, based on the penetrance and aggressiveness of the MTC. Children in the highest risk category should undergo thyroidectomy in their first year of life, and perhaps even in their first months of life. Children in the high-risk category should have ultrasound of the neck and calcitonin (CTN) measurement performed prior to thyroidectomy. Thyroidectomy should typically be performed at the age of 5 or earlier, depending on the presence of elevated serum CTN levels. However, heterogeneity in disease expression and progression within these groups varies considerably. To personalize disease management, the decision regarding the age of prophylactic thyroidectomy is no longer based upon genotype alone but is currently driven by additional clinical data, the most important being serum CTN levels; specifically, the decision to perform thyroidectomy should err on the safe side if the CTN level is elevated but below 30 pg/ml, especially in the moderate risk group. Personalized management also includes decisions about the best age to begin biochemical screening for pheochromocytoma and primary hyperparathyroidism.
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Affiliation(s)
- Karin Frank-Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr 21, 69120, Heidelberg, Germany.
| | - Friedhelm Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr 21, 69120, Heidelberg, Germany
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Abstract
Medullary thyroid cancer (MTC) can vary in tumor biology and progression. The most important indicator of distant metastases, determining clinical outcome, is lymph node metastasis to the neck and mediastinum. Surgical cure is within reach in node-negative tumors or node-positive tumors with fewer than 10 lymph node metastases. From a surgical point of view, compartment-oriented lymph node dissection, clearing gross, and occult metastases are important for locoregional tumor control. The discovery of missense germline mutations in the RET proto-oncogene and the close genotype-phenotype correlation in hereditary MTC promoted the worldwide breakthrough of prophylactic thyroidectomy. The best approach to hereditary MTC affords the DNA-based/biochemical concept, which is geared at limiting prophylactic surgery to total thyroidectomy at minimal surgical morbidity before the tumor can spread beyond the thyroid capsule. To improve outcome, routine calcitonin screening in nodular thyroid disease and DNA-based screening of the offspring in RET families are effective interventions.
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Affiliation(s)
- Andreas Machens
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle, Germany
| | - Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle, Germany.
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Bae YJ, Schaab M, Kratzsch J. Calcitonin as Biomarker for the Medullary Thyroid Carcinoma. Recent Results Cancer Res 2015; 204:117-37. [PMID: 26494386 DOI: 10.1007/978-3-319-22542-5_5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Calcitonin (CTN) is a polypeptide hormone consisting of 32 amino acids with a disulfide bridge between position 1 and 7 that is mainly produced by the C-cells of thyroid gland. The measurement of CTN concentrations in blood reflects C-cell activity and is performed in general by immunoassay methods. However, there are analytical, physiological, pharmacological, and pathological factors that can influence results of serum CTN values. Due to the influence of these factors, there is a high variability in assay-dependent cutoffs used to discriminate between MTC, C-cell hyperplasia (CCH), and the absence of the pathological impairment of C-cells. There is a lot of evidence that the measurement of serum CTN concentrations in patients with thyroid nodules can lead to an earlier diagnosis of MTC or CCH than the exclusive use of imaging procedures and/or fine-needle aspiration cytology. Basal CTN concentrations higher than 60-100 pg/mL are highly indicative for the diagnosis MTC. In the range between cutoff and 60 pg/mL CTN, both MTC and HCC may be a relevant diagnosis. PCT and CTN appear to have a comparable diagnostic capability to diagnose MTCs. However, "positive" PCT values of more than 50 pg/mL may be reached also in subclinical infections and will lead, therefore, to an overdiagnosis of the tumor. Pentagastrin- or calcium-stimulated serum CTN concentrations higher than cutoff values might improve diagnostics of MTC, but the non-availability of the first and the lacking of relevant cutoff values for the second tool favors the use of only basal values currently.
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Affiliation(s)
- Yoon Ju Bae
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universität Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Michael Schaab
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universität Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Juergen Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universität Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany.
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Camacho CP, Lindsey SC, Kasamatsu TS, Machado AL, Martins JRM, Biscolla RPM, Dias da Silva MR, Vieira JGH, Maciel RM. Development and application of a novel sensitive immunometric assay for calcitonin in a large cohort of patients with medullary and differentiated thyroid cancer, thyroid nodules, and autoimmune thyroid diseases. Eur Thyroid J 2014; 3:117-24. [PMID: 25114875 PMCID: PMC4109516 DOI: 10.1159/000363055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/18/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Serum calcitonin (sCT) is a useful biomarker for medullary thyroid cancer (MTC). Consensus has not been reached concerning sCT measurements in the evaluation of nodular thyroid disease (NTD). OBJECTIVE AND METHODS We developed a new immunofluorometric assay for sCT and have validated it in samples from 794 patients [203 with MTC, 205 with autoimmune thyroid disease (ATD), 248 with NTD, 80 with differentiated thyroid cancer (DTC) 'free of disease', 58 with chronic renal failure (CRF)] and 178 normal individuals, including samples after pentagastrin tests and samples from the washout of 92 FNA procedures in patients with NTD or MTC. We also compared some samples from patients with low or high calcitonin levels using both this assay and the Nichols Institute Diagnostics (NID) assay. RESULTS The assay's analytical sensitivity was 1.0 pg/ml. Considering MTC patients prior to surgery, the cut-off values for the 95% reference range were 11.1 pg/ml for males and 5.5 pg/ml for females and employing the ROC curve were 18.4 pg/ml for males and 7.8 pg/ml for females. sCT in patients with MTC was strongly correlated with disease status. Patients with NTD and ATD did not present false-positive results. sCT measurements were significantly correlated with age (excluding MTC and CRF). The NID test had a strong correlation with our assay. A hook effect was observed only with concentrations >200,000 pg/ml. CONCLUSIONS We developed a novel sCT assay and validated it in healthy subjects, as well as in a large cohort of patients with MTC, NTD, ATD, DTC, and CRF.
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Affiliation(s)
- Cléber P. Camacho
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Susan C. Lindsey
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Teresa S. Kasamatsu
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Alberto L. Machado
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
| | - João Roberto M. Martins
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Rosa Paula M. Biscolla
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
| | - Magnus R. Dias da Silva
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - José Gilberto H. Vieira
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
| | - Rui M.B. Maciel
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
- *Rui M.B. Maciel, MD, PhD, Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de, São Paulo, Rua Pedro de Toledo 669, 11th Floor, São Paulo, SP 04039-033 (Brazil), E-Mail
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d'Herbomez M, Bauters C, Cortet-Rudelli C, Dewailly D, Docao C, Wémeau JL. [Biomarkers in endocrinology]. Presse Med 2013; 43:40-56. [PMID: 24342177 DOI: 10.1016/j.lpm.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/12/2013] [Indexed: 10/25/2022] Open
Abstract
TSH assay is the best parameter of the thyroid function. For adults, the normal interval of TSH concentrations range from 0.4 to 4 mUI/L. At the first trimester of pregnancy, TSH levels must be <2.5 mUI/L. Normal TSH levels increase with aging and obesity. The biological diagnosis relies on the identification of excessive secretion of the metanephrines which are more sensitive and specific than those of catecholamines. The concentrations of the free plasmatic metanephrines reflect the ongoing production of tumor. Plasma methoxytyramine is a novel biomarker of metastatic pheochromocytomas and paragangliomas. Serum IGF1 is a reliable measure of integrated GH concentrations in patients with acromegaly. Accurate assessment of IGF1 concentrations requires age and sex-matched control values. IGF1 is a sensitive tool for the diagnosis of acromegaly and efficacy of therapies. Serum AMH assay is more sensitive, more specific and more reproducible that counting of ovarian follicles by ultrasound. AMH level above 5 ng/mL (35 pmol/L) could be chosen as one of the diagnostic criteria for the polycystic ovary syndrome. In early or "incipiens" ovarian failure, the decrease in serum AMH is far ahead of the increase in FSH. Thyroglobulin (TG) and calcitonin (CT) are the sensitive and specific markers of respectively well-differentiated thyroid cancers of follicular origin and of the medullary thyroid cancers. The same tumour marker assay should be used to monitor a given patient. Chromogranin A (CgA) is a highly efficient biomarker for diagnosis and follow-up of various endocrine tumours. Despite the lack of international standardisation, some CgA assays are reliable.
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Affiliation(s)
- Michèle d'Herbomez
- Université de Lille II, 59800 Lille, France; CHRU de Lille, centre de biologie-pathologie-génétique, rue Émile-Laine, 59037 Lille cedex, France.
| | - Catherine Bauters
- Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| | | | - Didier Dewailly
- Université de Lille II, 59800 Lille, France; Hôpital Jeanne-de-Flandre, service de gynécologie endocrinienne et médecine de la reproduction, 59037 Lille cedex, France
| | - Christine Docao
- Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| | - Jean-Louis Wémeau
- Université de Lille II, 59800 Lille, France; Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
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Timing and extent of thyroid surgery for gene carriers of hereditary C cell disease—a consensus statement of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 2013; 399:185-97. [DOI: 10.1007/s00423-013-1139-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/29/2013] [Indexed: 01/12/2023]
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Wells SA, Pacini F, Robinson BG, Santoro M. Multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma: an update. J Clin Endocrinol Metab 2013; 98:3149-64. [PMID: 23744408 PMCID: PMC5399478 DOI: 10.1210/jc.2013-1204] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Over the last decade, our knowledge of the multiple endocrine neoplasia (MEN) type 2 syndromes MEN2A and MEN2B and familial medullary thyroid carcinoma (FMTC) has expanded greatly. In this manuscript, we summarize how recent discoveries have enhanced our understanding of the molecular basis of these diseases and led to improvements in the diagnosis and management of affected patients. EVIDENCE ACQUISITION We reviewed the English literature through PubMed from 2000 to the present, using the search terms medullary thyroid carcinoma, multiple endocrine neoplasia type 2, familial medullary thyroid carcinoma, RET proto-oncogene, and calcitonin. EVIDENCE SYNTHESIS Over 70 RET mutations are known to cause MEN2A, MEN2B, or FMTC, and recent findings from studies of large kindreds with these syndromes have clouded the relationship between genotype and phenotype, primarily because of the varied clinical presentation of different families with the same RET mutation. This clinical variability has also confounded decisions about the timing of prophylactic thyroidectomy for MTC, the dominant endocrinopathy associated with these syndromes. A distinct advance has been the demonstration through phase II and phase III clinical trials that molecular targeted therapeutics are effective in the treatment of patients with locally advanced or metastatic MTC. CONCLUSIONS The effective management of patients with MEN2A, MEN2A, and FMTC depends on an understanding of the variable behavior of disease expression in patients with a specific RET mutation. Information gained from molecular testing, biochemical analysis, and clinical evaluation is important in providing effective management of patients with either early or advanced-stage MTC.
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Affiliation(s)
- Samuel A Wells
- Cancer Genetics Branch, National Cancer Institute, National Institutes of Health, Building 37, Room 10106A, 37 Convent Drive, Bethesda, Maryland 20814, USA.
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Abstract
Medullary thyroid carcinoma (MTC) is rare in children. MTC is almost always inherited and occurs as part of a multiple endocrine neoplasia type 2A and B, due to germline mutation in the RET proto-oncogene. MTC in the pediatric population is most often diagnosed in the course of a familial genetic investigation. But when the child is the proband, a de novo mutation is most often founded. The main aim is to treat MTC before extrathyroidal extension occurs because when distant metastases are present, it is rarely curable. Treatment is based on total thyroidectomy with cervical lymph node dissection.
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Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398:347-75. [PMID: 23456424 DOI: 10.1007/s00423-013-1057-6] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. METHODS The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. RESULTS The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. CONCLUSION These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
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Pina G, Dubois S, Murat A, Berger N, Niccoli P, Peix JL, Cohen R, Guillausseau C, Charrie A, Chabre O, Cornu C, Borson-Chazot F, Rohmer V. Is basal ultrasensitive measurement of calcitonin capable of substituting for the pentagastrin-stimulation test? Clin Endocrinol (Oxf) 2013; 78:358-64. [PMID: 22913268 DOI: 10.1111/cen.12001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 06/12/2012] [Accepted: 07/27/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate a second-generation assay for basal serum calcitonin (CT) measurements compared with the pentagastrin-stimulation test for the diagnosis of inherited medullary thyroid carcinoma (MTC) and the follow-up of patients with MTC after surgery. Recent American Thyroid Association recommendations suggest the use of basal CT alone to diagnose and assess follow-up of MTC as the pentagastrin (Pg) test is unavailable in many countries. DESIGN Multicentric prospective study. PATIENTS A total of 162 patients with basal CT <10 ng/l were included: 54 asymptomatic patients harboured noncysteine 'rearranged during transfection' (RET) proto-oncogene mutations and 108 patients had entered follow-up of MTC after surgery. MEASUREMENT All patients underwent basal and Pg-stimulated CT measurements using a second-generation assay with 5-ng/l functional sensitivity. RESULTS Ninety-five per cent of patients with basal CT ≥ 5 ng/l and 25% of patients with basal CT <5 ng/l had a positive Pg-stimulation test (Pg CT >10 ng/l). Compared with the reference Pg test, basal CT ≥ 5 ng/l had 99% specificity, a 95%-positive predictive value but only 35% sensitivity (P < 0.0001). Overall, there were 31% less false-negative results using a 5-ng/l threshold for basal CT instead of the previously used 10-ng/l threshold. CONCLUSION The ultrasensitive CT assay reduces the false-negative rate of basal CT measurements when diagnosing familial MTC and in postoperative follow-up compared with previously used assays. However, its sensitivity to detect C-cell disease remains lower than that of the Pg-stimulation test.
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Affiliation(s)
- Géraldine Pina
- Hospices Civils de Lyon et Université Lyon 1, Centre de Médecine Nucléaire, Centre d'Investigation Clinique et Fédération d'Endocrinologie, Groupement Hospitalier Est, Centre de Recherche en Neurosciences, Lyon, France.
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Elisei R, Alevizaki M, Conte-Devolx B, Frank-Raue K, Leite V, Williams G. 2012 European thyroid association guidelines for genetic testing and its clinical consequences in medullary thyroid cancer. Eur Thyroid J 2013; 1:216-31. [PMID: 24783025 PMCID: PMC3821492 DOI: 10.1159/000346174] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 11/30/2012] [Indexed: 01/09/2023] Open
Abstract
Twenty-five percent of medullary thyroid cancers (MTC) are familial and inherited as an autosomal dominant trait. Three different phenotypes can be distinguished: multiple endocrine neoplasia (MEN) types 2A and 2B, in which the MTC is associated with other endocrine neoplasias, and familial MTC (FMTC), which occurs in isolation. The discovery that germline RET oncogene activating mutations are associated with 95-98% of MEN 2/FMTC syndromes and the availability of genotyping to identify mutations in affected patients and their relatives has revolutionized the diagnostic and therapeutic strategies available for the management of these patients. All patients with MTC, both those with a positive familial history and those apparently sporadic, should be submitted to RET genetic screening. Once an RET mutation has been confirmed in an index patient, first-degree relatives should be screened rapidly to identify the 50% who inherited the mutation and are therefore at risk for development of MTC. Relatives in whom no RET mutation is identified can be reassured and discharged from further follow-up, whereas RET-positive subjects (i.e. gene carriers) must be investigated and a therapeutic strategy initiated. These guideline recommendations are derived from the most recent studies identifying phenotype-genotype correlations following the discovery of causative RET gene mutations in MEN 2 eighteen years ago. Three major points will be discussed: (a) identification of patients and relatives who should have genetic screening for RET mutations, (b) management of asymptomatic gene carriers, and (c) ethics.
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Affiliation(s)
- R. Elisei
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
- *Dr. Rossella Elisei, Department of Endocrinology, University of Pisa, Via Paradisa 2, IT–56124 Pisa (Italy), E-Mail
| | - M. Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Athens University School of Medicine, Athens, Greece
| | - B. Conte-Devolx
- Department of Endocrinology, La Timone Hospital, Aix Marseille University, Marseille, France
| | - K. Frank-Raue
- Endocrine Practice, Molecular Laboratory, Heidelberg, Germany
| | - V. Leite
- Department of Endocrinology, Portuguese Institute of Oncology and CEDOC, Faculty of Medical Sciences, Lisbon, Portugal
| | - G.R. Williams
- Molecular Endocrinology Group, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
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Abstract
Incremental advances in medical technology, such as the development of sensitive hormonal assays for routine clinical care, are the drivers of medical progress. This principle is exemplified by the creation of the concept of multiple endocrine neoplasia type 2, encompassing medullary thyroid cancer, pheochromocytoma, and primary hyperparathyroidism, which did not emerge before the early 1960s. This review sets out to highlight key achievements, such as joint biochemical and DNA-based screening of individuals at risk of developing multiple endocrine neoplasia type 2, before casting a spotlight on current challenges which include: (i) ill-defined upper limits of calcitonin assays for infants and young children, rendering it difficult to implement the biochemical part of the integrated DNA-based/biochemical concept; (ii) our increasingly mobile society in which different service providers are caring for one individual at various stages in the disease process. With familial relationships disintegrating as a result of geographic dispersion, information about the history of the origin family may become sketchy or just unavailable. This is when DNA-based gene tests come into play, confirming or excluding an individual's genetic predisposition to multiple endocrine neoplasia type 2 even before there is any biochemical or clinical evidence of the disease. However, the unrivaled molecular genetic progress in multiple endocrine neoplasia type 2 does not come without a price. Screening may uncover unknown gene sequence variants representing either harmless polymorphisms or pathogenic mutations. In this setting, functional characterization of mutant cells in vitro may generate helpful ancillary evidence with regard to the pathogenicity of gene variants in comparison with established mutations.
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Affiliation(s)
- Andreas Machens
- Department of General, Visceral and Vascular Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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Machens A, Spitschak A, Lorenz K, Pützer BM, Dralle H. Germline RET sequence variation I852M and occult medullary thyroid cancer: harmless polymorphism or causative mutation? Clin Endocrinol (Oxf) 2011; 75:801-5. [PMID: 21711375 DOI: 10.1111/j.1365-2265.2011.04158.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Rearranged during transfection (RET) gene analysis, widely used to identify carriers at risk of medullary thyroid cancer (MTC), occasionally uncovers novel sequence 'variants of unknown clinical significance' including RET I852M. This study aimed to clarify whether RET I852M represents a harmless polymorphism or a pathogenic mutation. DESIGN Clinical investigation supported by functional characterization of I852M mutant cells in vitro. PATIENTS AND MEASUREMENTS Genotype-phenotype correlation including five kindreds from a three-generational Caucasian I852M RET family. RESULTS A node-negative occult MTC was found in the 64-year-old index patient who had increased basal and stimulated peak calcitonin levels of 190 and 13 307 ng/l, respectively. Her 4-year-old grandson had no histopathological evidence of C-cell disease although his serum calcitonin levels had increased within 5 months from 3·2 to 6·3 ng/l basally and from 17·2 to 24·5 ng/l after pentagastrin stimulation. His mother and two 11- and 1·5-year-old siblings, also carrying the gene, had normal basal and stimulated calcitonin levels and hence did not undergo surgery. Functional characterization of transfected NIH3T3 cells in vitro (cell proliferation rate; cell viability; anchorage-independent cell growth; cell migration; and invasion) indicated that I852M mutant cells have transforming and migratory activities similar to American Thyroid Association (ATA) class A V804M mutants. I852M mutants demonstrated a weaker proliferative potential than fast-proliferating ATA class C C634R mutants and revealed a weaker migratory activity compared with aggressively growing ATA class D A883F mutants. CONCLUSIONS I852M sequence variations represent genuine RET mutations, falling into ATA class A of weakly activating RET germline mutations.
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Affiliation(s)
- Andreas Machens
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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d'Herbomez M. [Calcitonin: indications and interpretation]. Presse Med 2011; 40:1141-6. [PMID: 22035862 DOI: 10.1016/j.lpm.2011.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/17/2011] [Accepted: 05/20/2011] [Indexed: 10/15/2022] Open
Abstract
Calcitonin is the sensitive and specific marker of the medullary thyroid cancers. It is a diagnostic, pronostic and follow-up marker. Medullary thyroid cancer is a rare disease representing 4% of the thyroid cancers and occurring in 0.4% of nodular thyroid pathology. The use of sex specific adults normal ranges allows a better interpretation of the moderately elevated calcitonin levels. Hypercalcitoninaemia non due to medullary thyroid cancer are attributed mainly to male sex, tobacco use, overweight, renal failure and other endocrine tumors. CT is associated to carcinoembryonic antigen and possible procalcitonin assays. Calcitonin can be assayed in the wash-out fluid of the fine needle aspiration too. Stimulation tests give poor additional diagnostic information and are about to be abandoned.
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