Enhanced Calcitonin Release in Chronic Renal Failure Depending on the Absence of Severe Secondary Hyperparathyroidism

Mulder, H.; Silberbusch, J.; Hackeng, W. H. L.; Koorevaar, G.; Ottolander, G.J.H. den

doi:10.1159/000182630

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…In contrast with Mulder et al (8), who demonstrated an enhanced response to intravenous calcium in chronic renal failure, CT response to pentagastrin, expressed as the AUC, was normal in the present study. Moreover, we did not find differences between patients with chronic renal failure and healthy subjects in the rising branch of the AUC, used here as a more accurate index of the C cell response.…”

Section: Discussioncontrasting

confidence: 99%

“…This finding is in agreement with previous results showing that the C cell response depends on the degree of hyperparathyroidism in this entity (8). This finding is in agreement with previous results showing that the C cell response depends on the degree of hyperparathyroidism in this entity (8).…”

Section: Discussionsupporting

confidence: 93%

“…Mulder et al, using an RIA method, found an enhanced CT release after intravenous calcium infusion (8). Mulder et al, using an RIA method, found an enhanced CT release after intravenous calcium infusion (8).…”

mentioning

confidence: 99%

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Normal calcitonin response to pentagastrin stimulation in patients with chronic renal failure

Escalada

Teruel²,

Pavón³

et al. 1993

Acta Endocrinologica

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High calcitonin levels have been reported in chronic renal failure. To study the C cell response in patients with chronic renal failure, an intravenous bolus of pentagastrin was administered to 11 patients and 11 healthy subjects. Samples were obtained at 0,1,2, 3, 5 and 10 min for calcitonin assay. In order to detect only the active monomeric calcitonin, an immunoradiometric assay method was used. The influence of calcium, phosphate, alkaline phosphatase and intact parathyroid hormone was also evaluated. Although basal calcitonin levels were higher (p<0.01) in chronic renal failure (mean\m=+-\sem:10.1 \m=+-\2.9 pmol/l) versus healthy subjects (1.1 \m=+-\0.3pmol/l), the area under the curve showed there to be no differences between the two groups. The rising branch of the area under the curve, employed as an expression of the C cell response capacity, showed no differences either (chronic renal failure vs healthy subjects: 5.6\m=+-\2vs 2.6\m=+-\0.7pmol l \ m=-\ 1 min\m=-\1, p=0.28). In the chronic renal failure group, a positive correlation was found (r=0.625, p<0.05) between the rising branch of the area under the curve and parathyroid hormone. We conclude that monomeric calcitonin is increased in chronic renal failure, but C cells of the thyroid respond to pentagastrin, as they do in normal subjects. This finding is of great clinical importance when a patient with renal impairment is evaluated for medullary thyroid carcinoma. The calcitonin response to pentagastrin seems to be related directly to the degree of secondary hyperparathyroidism in chronic renal failure.The basal calcitonin (CT) concentration has been found to be high in most of the patients with chronic renal failure (1, 2), probably due to a low hormone renal clearance (3). As RIA detects both less-active polymeric CT and highly active monomeric CT forms (4), Motte et al. (5) recently have described an immunoradiometric assay (IRMA) that only detects monomeric CT. This new assay has confirmed the high CT basal values, previously shown by RIA, in patients with chronic renal failure (6).The C cell response capacity has been studied only barely in chronic renal failure (7). Mulder et al., using an RIA method, found an enhanced CT release after intravenous calcium infusion (8). Intravenous penta¬ gastrin is a pharmacological stimulus of CT secretion, frequently used in the diagnosis of medullary thyroid carcinoma (6). In this report, we performed a CT IRMA in response to the pentagastrin test in advanced chronic renal failure in order to assess the C cell response in this entity. The influence of several factors, such as calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase, was also evaluated. Subjects and materialWe studied eleven patients (eight men and three women, aged 16-72 years) with advanced chronic renal failure (mean plasma creatinine±sem: 831 ±70.7 /¿mol/1, range 300-1202 ¿tmol/1) who had not yet received dialysis treatment, and eleven healthy subjects (six men and five women, aged 25-40 years). Both patients and normal con...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 93%

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Normal calcitonin response to pentagastrin stimulation in patients with chronic renal failure

Escalada

Teruel²,

Pavón³

et al. 1993

Acta Endocrinologica

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“…In patients with chronic kidney disease (CKD), the CT concentration is known to be increased in about 30% (8)(9)(10)(11). Whether this phenomenon reflects only an accumulation due to decreased CT clearance or an increased CT secretion is not known.…”

Section: Introductionmentioning

confidence: 99%

“…Whether this phenomenon reflects only an accumulation due to decreased CT clearance or an increased CT secretion is not known. Only few studies examined C-cell response to pentagastrin or calcium in patients with impaired kidney function and revealed controversial results (8)(9)(10)(11)(12) Therefore, the decision making with regard to medullary thyroid carcinoma is challenging for a patient with CKD and elevated CT serum levels.…”

Section: Introductionmentioning

confidence: 99%

Reversibility of ′Secondary Hypercalcitoninemia′ After Kidney Transplantation

Borchhardt

Hörl

Sunder‐Plassmann

2005

American Journal of Transplantation

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Whether the increase of calcitonin (CT) concentration in patients with chronic kidney disease (CKD) is reversible or not after kidney transplantation is not known. We examined the effect of kidney transplantation on basal and pentagastrin-stimulated CT in CKD patients with elevated screening CT levels.Before transplantation, the median basal CT concentration of 17 patients was 31 pg/mL (13-76), and decreased to 8 pg/mL (4-28) at 23 months (2-34) after kidney transplantation (p < 0.00005). The maximum concentration of pentagastrin-stimulated CT was 63 pg/mL (25-110) before transplantation and decreased to 20 pg/mL (8-91) (p < 0.00005) thereafter. There was a linear association between CT and calcium as well as between phosphorus and parathyroid hormone at the time of screening. After transplantation, CT correlated with serum creatinine. Therefore, the increase of CT concentration in patients with impaired kidney function presumably reflects 'secondary hypercalcitoninemia' due to C-cell hyperactivity.

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Calcitonin as Biomarker for the Medullary Thyroid Carcinoma

Bae

Schaab

Kratzsch

2015

Recent Results in Cancer Research

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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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Enhanced Calcitonin Release in Chronic Renal Failure Depending on the Absence of Severe Secondary Hyperparathyroidism

Cited by 10 publications

References 15 publications

Normal calcitonin response to pentagastrin stimulation in patients with chronic renal failure

Normal calcitonin response to pentagastrin stimulation in patients with chronic renal failure

Reversibility of ′Secondary Hypercalcitoninemia′ After Kidney Transplantation

Calcitonin as Biomarker for the Medullary Thyroid Carcinoma

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