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11 "Calcitonin"
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Original Articles
Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy
Sung Hye Kong, Seung Shin Park, Jung Hee Kim, Sang Wan Kim, Se Hyun Kim, Jee Hyun Kim, Chan Soo Shin
Received August 2, 2024  Accepted October 29, 2024  Published online February 4, 2025  
DOI: https://doi.org/10.3803/EnM.2024.2132    [Epub ahead of print]
  • 133 View
  • 7 Download
AbstractAbstract PDF
Background
Hypercalcemia of malignancy (HCM), a major metabolic complication of cancer, is often managed with bisphosphonates (BP) and, increasingly, with denosumab. We aimed to compare the effectiveness and safety of denosumab with that of BP, with or without calcitonin, in treating HCM.
Methods
This retrospective cohort study was conducted at a tertiary hospital from 2017 to 2022 and included 317 patients treated for HCM. Participants were divided into three treatment groups: denosumab, intravenous (IV) BP only, and IV BP combined with calcitonin. The primary outcomes measured were changes in calcium levels and the incidence of hypocalcemia. Analysis of covariance was used to adjust for age, sex, body mass index, creatinine level, type of malignancy, and the use of furosemide and steroids.
Results
The mean participant age was 65 years, and 37.5% were female. After adjustment, both denosumab and IV BPs were found to effectively lower calcium levels. Denosumab led to a decrease of 2.0 mg/dL (−15.9%), while IV BP alone resulted in a reduction of 1.8 mg/dL (−13.9%). The largest reduction, of 2.7 mg/dL (−20.9%), occurred with IV BP and calcitonin. Both denosumab and IV BP+calcitonin yielded their lowest calcium levels within 48 hours, whereas the IV BP only group reached a nadir within 72 hours. Despite these differences in treatment effectiveness, hypocalcemia occurred significantly less frequently in the denosumab group compared to the other groups.
Conclusion
Denosumab and IV BP were similarly effective in reducing calcium levels. However, IV BP combined with calcitonin yielded a more rapid and pronounced decrease.
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Clinical Study
Gender-Dependent Reference Range of Serum Calcitonin Levels in Healthy Korean Adults
Eyun Song, Min Ji Jeon, Hye Jin Yoo, Sung Jin Bae, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Hong-Kyu Kim, Won Gu Kim
Endocrinol Metab. 2021;36(2):365-373.   Published online April 7, 2021
DOI: https://doi.org/10.3803/EnM.2020.939
  • 6,558 View
  • 166 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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.

Citations

Citations to this article as recorded by  
  • Determinants of circulating calcitonin value: analysis of thyroid features, demographic data, anthropometric characteristics, comorbidities, medications, and smoking habits in a population with histological full exclusion of medullary thyroid carcinoma
    Pierpaolo Trimboli, Giuseppe Peloni, Dorotea Confalonieri, Elena Gamarra, Tommaso Piticchio, Francesco Frasca, Petra Makovac, Arnoldo Piccardo, Lorenzo Ruinelli
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Surgical treatment of solid variant of papillary thyroid carcinoma: Fifteen-year experience of a tertiary center
    Katarina Tausanović, Marina Stojanović, Milan Jovanović, Boban Stepanović, Jovan Ilić, Sara Ivaniš, Vladan Živaljević
    Medicinska istrazivanja.2024; 57(1): 121.     CrossRef
  • Impact of dietary, lifestyle and sociodemographic factors on calcitonin levels in a healthy population
    Ivana Gunjača, Mirjana Babić Leko, Nikolina Pleić, Ante Jurić, Dubravka Brdar, Vesela Torlak, Marko Vuletić, Ante Punda, Ozren Polašek, Caroline Hayward, Tatijana Zemunik
    Bone.2024; 187: 117214.     CrossRef
  • Some genetic differences in patients with rheumatoid arthritis
    Hosam M. Ahmad, Zaki M. Zaki, Asmaa S. Mohamed, Amr E. Ahmed
    BMC Research Notes.2023;[Epub]     CrossRef
  • Presence or severity of Hashimoto’s thyroiditis does not influence basal calcitonin levels: observations from CROHT biobank
    M. Cvek, A. Punda, M. Brekalo, M. Plosnić, A. Barić, D. Kaličanin, L. Brčić, M. Vuletić, I. Gunjača, V. Torlak Lovrić, V. Škrabić, V. Boraska Perica
    Journal of Endocrinological Investigation.2022; 45(3): 597.     CrossRef
  • Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels
    Mirjana Babić Leko, Nikolina Pleić, Ivana Gunjača, Tatijana Zemunik
    International Journal of Molecular Sciences.2021; 23(1): 44.     CrossRef
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Case Report
A Case of Calcitonin Secreting Pheochromocytoma.
Joo Won Byun, Young Goo Shin, Choon Hee Chung, Young Jun Won, Yoon Jong Choi, Eui Ryun Park, Mi Duck Lee, Chang Ho Song, Mi Youn Cho, Sung Jun Kang
J Korean Endocr Soc. 1996;11(3):343-347.   Published online November 7, 2019
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  • 34 Download
AbstractAbstract PDF
Pheochromocytoma is a catecholamine producing turnor and raise with less than 0.1% of hypertensive patients. It is developed, most commonly, in sporadic pheochromocytoma or multiple endocrine neoplasia type 2. Therefore, when hypercalcitoninemia is found in a patient with pheochromocytoma, the possibility of multiple endocrine neoplasia type 2 or the ectopic secretion of calcitonin must be considered. Recently we experienced a 45 year old male patient with sporadic pheochrornocytoma. He also had hypercalcitoninemia and normocalcemia. After the removal of pheochromocytoma, serum calcitnnin level returned to normal. Secretion of calcitonin was confirmed by immunohisto- chemical stain.
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Original Articles
Clinical Significance of Routine Measurement of Serum Calcitonin in Korean Patients with Thyroid Nodules as a Screening test of Sporadic Thyroid Medullary Carcinoma.
Young Kee Shong, Cheol Soo Choi, Hye Young Park, Bo Youn Cho
J Korean Endocr Soc. 1996;11(1):11-17.   Published online November 7, 2019
  • 1,256 View
  • 27 Download
AbstractAbstract PDF
Background
: It is not easy to diagnose sporadic medullary thyroid carcinoma(MTC) before surgery and this might lead the patient reoperation and/or lowered chance of definite cure. Methods : The prevalence of sporadic MTC in Korean was studied in patients with thyroid nodules. A prospective study of 1048 consecutive patients with thyroid nodules was performed. In all patients, measurements of basal serum calcitonin, thyroid hormones, TSH, anti-thyroglobulin antibody and anti-thyroperoxidase antibody were undertaken along with technetium-99m thyroid scintigraphy and fine needle aspiration cytology. In patients with elevated basal calcitonin levels, calcium stimulated calcitonin level was determined. Results: Two patient had markedly elevated calcitonin levels(over 3,200 pg/mL and 1,763 pg/ mL) and another one slightly elevated calcitoni#n(71.9 pg/mL). Fine needle aspiration cytology was suggestive of MTC in one and nodular hyperplasia in the other two. They underwent surgery and histological examination revealed MTC in those two with markedly elevated calcitonin levels. The patient with slightly elevated calcitonin, who was on the maintenance hemodialysis due to chronic renal failure, had nodular hyperplasia. Conclusion: MTC was found in 0.19% of patients with thyroid nodules, which was not different with the previously reported prevalence in Europe. Routine measurements of serum calcitonin might be of value to detect sporadic MTC; however, the cost-effectiveness of routine measurement of serum calcitonin is not clear, considering the relatively low prevalence of MTC in Koreans.
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Thyroid
Procalcitonin as Marker of Recurrent Medullary Thyroid Carcinoma: A Systematic Review and Meta-Analysis
Pierpaolo Trimboli, Luca Giovanella
Endocrinol Metab. 2018;33(2):204-210.   Published online June 21, 2018
DOI: https://doi.org/10.3803/EnM.2018.33.2.204
  • 5,727 View
  • 67 Download
  • 13 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Calcitonin measurement is pivotal in the management of medullary thyroid carcinoma (MTC), but several pitfalls can affect its reliability. Other potential markers have been proposed, and procalcitonin (ProCT) has been reported as promising. The present study was undertaken to summarize the published data and provide more robust estimates on the reliability of ProCT as marker in the management of patients with MTC.

Methods

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The sources comprised studies published through May 2018. Original articles that reported series of MTC patients undergone ProCT during postoperative follow-up were searched. A random-effects model was used for statistical pooling of the data. The I2 index was used to quantify the consistency among the studies. The Egger test evaluated the possible presence of significant publication bias. Quality assessment of the studies was performed according to Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).

Results

According to inclusion and exclusion criteria five papers, reporting 296 MTC patients undergone ProCT evaluation, were finally selected. The number of MTC with recurrence was 140. The pooled sensitivity of ProCT in detecting recurrence was 96% (95% confidence interval [CI], 92% to 99%), with neither heterogeneity (I2=0%) nor publication bias (Egger test, 3.16; P=0.99). The pooled specificity was 96% (95% CI, 87% to 100%) with mild heterogeneity (I2=66.6%), while Egger test was not calculable.

Conclusion

The present meta-analysis provides evidence that ProCT is reliable to manage MTC patients during their postoperative follow-up.

Citations

Citations to this article as recorded by  
  • Thyroid cancer quality of care indicators: A scoping review
    Kimia Ameri, Michelle Kwon, Akie Watanabe, Sam M. Wiseman
    The American Journal of Surgery.2025; : 116223.     CrossRef
  • Insulinoma with Hyperprocalcitoninemia and Hypercalcitoninemia Showing Coexpression of Insulin and Calcitonin in Its Tumor Cells
    Tomoko Kaketaka, Ikuo Mineo, Yu Kimura, Naohiko Ito, Yukiyoshi Okauchi, Hiromi Tamura, Shiro Adachi, Hiromi Iwahashi
    Internal Medicine.2024; 63(10): 1415.     CrossRef
  • Diagnostic Performance of Preoperative Calcitonin and Procalcitonin Tests for Differential Diagnosis of Medullary Thyroid Cancer
    Il Youb Jeong, Hyeok Jun Yun, Seok-Mo Kim, Yongjung Park
    Diagnostics.2024; 14(16): 1809.     CrossRef
  • Febrility in malignant disease
    Štefan Sotak
    Vnitřní lékařství.2024; 70(8): 508.     CrossRef
  • [111In]In-CP04 as a novel cholecystokinin-2 receptor ligand with theranostic potential in patients with progressive or metastatic medullary thyroid cancer: final results of a GRAN-T-MTC Phase I clinical trial
    Luka Lezaic, Paola Anna Erba, Clemens Decristoforo, Katja Zaletel, Renata Mikolajczak, Helmut Maecke, Theodosia Maina, Mark Konijnenberg, Petra Kolenc, Malgorzata Trofimiuk-Müldner, Elwira Przybylik-Mazurek, Irene Virgolini, Marion de Jong, Alide C Fröber
    European Journal of Nuclear Medicine and Molecular Imaging.2023; 50(3): 892.     CrossRef
  • Diagnostic tests for medullary thyroid carcinoma: an umbrella review
    Pierpaolo Trimboli, Caterina Mian, Arnoldo Piccardo, Giorgio Treglia
    Endocrine.2023; 81(2): 183.     CrossRef
  • Advances in Diagnostics and Therapy of Medullary Thyroid Carcinoma (MTC)– A Mini-Review
    Michał Miciak, Krzysztof Jurkiewicz
    Clinical Cancer Investigation Journal.2023; 12(5): 1.     CrossRef
  • Role of Polypeptide Inflammatory Biomarkers in the Diagnosis and Monitoring of COVID-19
    Aparajita Sen, Arti Nigam, Meenakshi Vachher
    International Journal of Peptide Research and Therapeutics.2022;[Epub]     CrossRef
  • A pregnancy-specific reference interval for procalcitonin
    Samuel Dockree, Jennifer Brook, Tim James, Brian Shine, Manu Vatish
    Clinica Chimica Acta.2021; 513: 13.     CrossRef
  • Clinical performance of calcitonin and procalcitonin Elecsys® immunoassays in patients with medullary thyroid carcinoma
    Luca Giovanella, Martina Fontana, Franco Keller, Frederik A. Verburg, Luca Ceriani
    Clinical Chemistry and Laboratory Medicine (CCLM).2021; 59(4): 743.     CrossRef
  • Correlation between preoperative ultrasonic features of medullary thyroid carcinoma and postoperative recurrence
    Qiaodan Zhu, Dong Xu
    BMC Cancer.2021;[Epub]     CrossRef
  • Calcitonin and complementary biomarkers in the diagnosis of hereditary medullary thyroid carcinoma in children and adolescents
    Felix Eckelt, Roland Pfaeffle, Wieland Kiess, Juergen Kratzsch
    Journal of Pediatric Endocrinology and Metabolism.2021; 34(12): 1491.     CrossRef
  • Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis
    Marisa A. Bartz-Kurycki, Omowunmi E. Oluwo, Lilah F. Morris-Wiseman
    Therapeutic Advances in Endocrinology and Metabolism.2021;[Epub]     CrossRef
  • Diagnostic Challenges of Medullary Thyroid Carcinoma
    Robert D. Leimbach, Thanh D. Hoang, Mohamed K.M. Shakir
    Oncology.2021; 99(7): 422.     CrossRef
  • The Diagnostic and Antibiotic Reference Values of Procalcitonin for Intracranial Infection After Craniotomy
    Lei Zhu, Lun Dong, Yuping Li, Guangyu Lu, Hengzhu Zhang, Xingdong Wang, Xiaoguang Liu, Zhenfei Teng, Boming Xia, Peng Zhang
    World Neurosurgery.2019; 126: e1.     CrossRef
  • Triennial Report ofEndocrinology and Metabolism, 2015 to 2017
    Eun-Jung Rhee, Hey Yeon Jang, Won-Young Lee
    Endocrinology and Metabolism.2018; 33(2): 195.     CrossRef
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Case Reports
Thyroid
A Calcitonin-Negative Neuroendocrine Tumor Derived from Follicular Lesions of the Thyroid
Ga Young Kim, Chul Yun Park, Chang Ho Cho, June Sik Park, Eui Dal Jung, Eon Ju Jeon
Endocrinol Metab. 2015;30(2):221-225.   Published online December 9, 2014
DOI: https://doi.org/10.3803/EnM.2015.30.2.221
  • 4,387 View
  • 37 Download
  • 7 Web of Science
  • 9 Crossref
AbstractAbstract PDFPubReader   

Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.

Citations

Citations to this article as recorded by  
  • Medullary thyroid carcinoma with ACHT-dependent Cushing's syndrome: Therapeutic possibilities
    Dušan Ilić, Sanja Ognjanović, Bojana Popović, Valentina Elezović-Kovačević, Milica Opalić-Palibrk, Lena Radić, Katarina Krstić, Đuro Macut
    Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma.2024; 29(93): 46.     CrossRef
  • Calcitonin-Negative Neuroendocrine Carcinoma of the Thyroid Gland: Case Report and Literature Review
    Ricardo Fernández-Ferreira, Ildefonso Roberto De la Peña-López, Karla Walkiria Zamudio-Coronado, Luis Antonio Delgado-Soler, María Eugenia Torres-Pérez, Christianne Bourlón-de los Ríos, Rubén Cortés-González
    Case Reports in Oncology.2021; 14(1): 112.     CrossRef
  • Calcitonin-negative neuroendocrine tumor of the thyroid with metastasis to liver-rare presentation of an unusual tumor: A case report and review of literature
    Huai-Jie Cai, Han Wang, Nan Cao, Bin Huang, Fan-Lei Kong, Li-Ren Lu, Ya-Yuan Huang, Wei Wang
    World Journal of Clinical Cases.2020; 8(1): 179.     CrossRef
  • Medullary thyroid carcinoma with double negative calcitonin and CEA: a case report and update of literature review
    Claudio Gambardella, Chiara Offi, Guglielmo Clarizia, Roberto Maria Romano, Immacolata Cozzolino, Marco Montella, Rosa Maria Di Crescenzo, Massimo Mascolo, Angelo Cangiano, Sergio Di Martino, Giancarlo Candela, Giovanni Docimo
    BMC Endocrine Disorders.2019;[Epub]     CrossRef
  • Calcitonin negative Medullary Thyroid Carcinoma: a challenging diagnosis or a medical dilemma?
    Claudio Gambardella, Chiara Offi, Renato Patrone, Guglielmo Clarizia, Claudio Mauriello, Ernesto Tartaglia, Francesco Di Capua, Sergio Di Martino, Roberto Maria Romano, Lorenzo Fiore, Alessandra Conzo, Giovanni Conzo, Giovanni Docimo
    BMC Endocrine Disorders.2019;[Epub]     CrossRef
  • Calcitonin-Negative Neuroendocrine Tumor of the Thyroid
    Megan Parmer, Stacey Milan, Alireza Torabi
    International Journal of Surgical Pathology.2017; 25(2): 191.     CrossRef
  • Clinical and pathological analysis of 19 cases of medullary thyroid carcinoma without an increase in calcitonin
    Qiufeng Zhou, Shuanglei Yue, Ye Cheng, Ju Jin, Haimiao Xu
    Experimental and Toxicologic Pathology.2017; 69(8): 575.     CrossRef
  • Primary Calcitonin-negative Neuroendocrine Tumor
    Sabri Özden, Aysel Colak, Baris Saylam, Ömer Cengiz
    World Journal of Endocrine Surgery.2017; 9(3): 104.     CrossRef
  • LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH FOLLICULAR TUMORS OF THE THYROID
    I. N. Zubarovskiy, M. V. Mikhailova, S. K. Osipenko
    Grekov's Bulletin of Surgery.2015; 174(5): 32.     CrossRef
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A Case of Residual Medullary Thyroid Carcinoma Detected by 18F-FDG-PET/CT in Patient with Persistent Hypercalcitoninemia.
Ji Yon Kim, Dong Won Byun, Kyo Il Seo, So Young Jin, Myung Hi Yoo
Endocrinol Metab. 2010;25(4):365-369.   Published online December 1, 2010
DOI: https://doi.org/10.3803/EnM.2010.25.4.365
  • 2,035 View
  • 24 Download
AbstractAbstract PDF
Medullary thyroid carcinoma (MTC) is a rare and challenging malignancy. In patients with residual MTC, the tumor detection rate is generally low for most of the currently available imaging techniques. Various imaging methods have already been used for the detection of residual tumor, but no modality has been shown to be superior to others. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been proposed to identify residual MTC, but this procedure also has limitations as small masses are rarely detected. So, a multimodality imaging approach is recommended for detecting residual MTC. We report here on a case of residual MTC that was detected by 18F-FDG PET/CT in a patient with persistent hypercalcitoninemia after total thyroidectomy and bilateral lymph node dissection.
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Original Articles
Search for Materials that Influence Human Medullary Thyroid Carcinoma Cell Proliferation.
Hyun Won Shin, Hye Won Jang, Keun Sook Kim, Ji In Lee, Ji Young Park, Sun Wook Kim, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
J Korean Endocr Soc. 2009;24(2):93-99.   Published online June 1, 2009
DOI: https://doi.org/10.3803/jkes.2009.24.2.93
  • 2,457 View
  • 20 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Surgical excision is the only effective treatment of medullary thyroid carcinoma (MTC) and there is no certain treatment for recurrence or distant metastasis. Materials that influence MTC cell proliferation were recently reported. Presently, we evaluated the influence of dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin and gastrin on MTC cell proliferation and calcitonin secretion. METHODS: Genomic DNA was extracted and sequenced from untreated thyroid TT cells and cells treated with 10-5~10-10 M dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin or gastrin, and cultured for 1~6 days. Cell proliferation was assessed using a BrdU assay at days 1, 2, 3, and 6. Calcitonin in the culture medium from dexamethasone-treated TT cells was measured at days 1~3. RESULTS: Replacement of cysteine with tryptophan at codon 634 of exon 11 was evident in treated TT cells. There was no significant difference in cell proliferation at days 1~3 in cells treated with somatostatin, progesterone, estradiol-17-beta, gastrin and forskolin, while proliferation was inhibited in dexamethasone-treated cells in a concentration-dependent manner from 10-5~10-8 M with no inhibition evident at 10-10 M. Calcitonin levels in 10-5~10-8 M dexamethasone-treated cells were decreased. CONCLUSION: Dexamethasone is a potentially useful compound to suppress MTC cell proliferation. Further studies are necessary to explore this potential further prior to clinical use.

Citations

Citations to this article as recorded by  
  • Identification of Growth Regulatory Factors in Medullary Thyroid Carcinoma Cell Line
    Young Suk Jo, Minho Shong
    Journal of Korean Endocrine Society.2009; 24(2): 84.     CrossRef
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Early Detection of Medullary Thyroid Cancer by Screening of the RET Proto-oncogene Germ Line Point Mutation in Family Members Affected with Hereditary Medullary Thyroid Cancer .
Sun Wook Kim, Tae Yong Kim, Young Joo Park, Won Bae Kim, Chan Soo Shin, Do Joon Park, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2001;16(1):54-64.   Published online February 1, 2001
  • 1,275 View
  • 18 Download
AbstractAbstract PDF
BACKGROUND
Conventional biochemical screening for family members with hereditary medullary thyroid cancer (MTC) is associated with problems of sensitivity and, specificity and it frequently detects gene carriers only after disease progression. Molecular genetic screening tests that detect germ-line point mutations of the RET proto-oncogene has changed our approach to hereditary MTC. In this study we screened members of a large Korean family that had a history of hereditary MTC by a molecular genetic method and propose a therapeutic approach in managing the disorder. METHODS: Using DNA acquired from peripheral blood leukocytes of the index patient, we performed PCR and direct sequencing of exon 10 of the RET proto-oncogene. PCR-RFLP using an Mbo II restriction enzyme was performed on family members who were at risk of MTC according to the family pedigree. Basal serum calcitonin level was determined in family members who had a point mutation of the RET proto-oncogene and a pentagastrin stimulation test was performed in 3 members. RESULTS: Genetic analysis in the index case revealed a mutation in exon 10, codon 618 of the RET proto-oncogene (TGC to AGC). Out of 28 members who were at risk of MTC, 24 members participated in the screening test. 9 members tested positive for a mutation in the same chromosomal location as the index patient by PCR-RFLP. Basal serum calcitonins were above 100 pg/mL in 2 members. 3 members who had a RET point muatation but a normal basal serum calcitonin level participated in the pentagastrin stimulation test and the results were negative in all members. We found a small medullary thyroid carcinoma that had a diameter of 0.2 cm in a 16 years old boy according to a negative pentagastrin stimulation test and who had received a prophylactic total thyroidectomy. He had no evidence of a lymph node metastasis. CONCLUSION: We detected a germ-line mutation of the RET proto-oncogene in codon 618 of Exon 10 by a molecular genetic method in a family with a hereditary MTC and found 9 members that had a negative history of MTC but had a RET point mutation. There was a very small MTC found in a 16 years old boy who had a normal pentagastrin stimulation test result. Therefore, It is recommended that a prophylactic total thyroidectomy be performed as well as in members that have a mutation of the RET proto-oncogene because MTC can metastasize early in its disease course.'
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Routine Measurement of Serum Calcitonin Concentration is Useful in Early Detection of Medullary Thyroid Carcinoma Among Patients with Nodular Thyroid Disease.
Jong Ryeal Hahm, Jae Hoon Chung, Eun Young Oh, In Kyung Chung, Tae Young Yang, Dong Jun Kim, Byung Ju Kim, Sung Hoon Kim, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim
J Korean Endocr Soc. 2000;15(1):70-84.   Published online January 1, 2001
  • 1,416 View
  • 20 Download
AbstractAbstract PDF
BACKGROUND
Serum calcitonin is a sensitive and specific marker for diagnosis of medullary thyroid carcinoma (MTC) and its determination leads to accurate preoperative diagnosis and gives chances of definite cure. However, since many non-MTC diseases are also associated with calcitonin elevation, its significance in patients with mild or moderately elevated basal serum calcitonin levels is not clear. Furthermore, the normal value of calcitonin using immunoradiometric assay (IRMA) kit has not so far been definitely ascertained. This study is aimed at assessing the clinical significance of routine measurement of serum basal calcitonin concentration in nodular thyroid disease patients and evaluating the pentagastrin stimulation test in case of mild or moderate elevation of basal calcitonin level. We also measured serum calcitonin value in 408 normal individuals. METHODS: The basal serum calcitonin concentrations using a commercial IRMA kit (Medgenix CT-U.S.-IRMA) were measured in 818 patients with nodular thyroid disease (average age 45 years with a range from 13 to 82 years; 125 males and 693 females) who visited thyroid clinics in Samsung Medical Center between June 1997 and December 1998. Serum concentrations of T3, T4, TSH and thyroid autoantibodies were measured and ultrasonography of thyroid and thyroid scan using 131I or 99mTc-pertechnetate were performed in all patients. We also studied 408 healthy subjects without any thyroid disease (average age 48 years with a range from 20 to 86 years; 224 females). RESULTS: The calcitonin value in normal subjects was found to range from 0 to 13 pg/mL, and it was shown that men had higher calcitonin level than women (p< 0.05). The rate of serum calcitonin elevation (> 10pg/mL) in nodular thyroid disease was 1.71% (14/818), and the incidence of MTC was 0.73% (6/818) in this study. MTC was found in all patients with basal serum calcitonin levels more than 100 pg/mL. Pentagastrin stimulation test was also required to diagnose MTC in patients with basal serum calcitonin levels between 30 and 100pg/mL. The calcitonin concentration stimulated by pentagastrin increased more than 400pg/mL or more than 3.8 times of basal concentration. It was possible to diagnose MTC with fine needle aspiration and cytology in only one case out of six patients with MTC. CONCLUSION: Fine needle aspiration and cytology in diagnosing MTC was not sensitive and not devoid of false positive results. We confirmed that serum calcitonin measurement was very useful means for the preoperative diagnosis of unsuspected MTC. Pentagastrin stimulation test may be a reliable means of evaluation in nodular thyroid disease patients with mild or moderate elevation of basal calcitonin level. We recommend routine measurement of serum calcitonin concentration in patients with nodular thyroid disease.
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Case Report
A Case of Diabetes Mellitus Caused by Calcitonin and Somatostatin Secreting Pancreatic Islet Tumor.
Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Jong Ryol Ham, Dong Joon Kim, Hoe Jung Lee, Young Ryoon Oh
J Korean Endocr Soc. 1999;14(2):425-431.   Published online January 1, 2001
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AbstractAbstract PDF
A case of 39-year-old diabetic patient with a calcitonin and somatostatin secreting pancreatic islet tumor is presented. He had suffered from chronic diarrhea and dyspepsia for 10 years and was diagnosed with diabetes 2 years ago. Abdominal CT revealed a huge abdominal mass which was considered as a neuroendocrine tumor after US-guided needle biopsy. A distal pancreatectomy and splenectomy were performed. Histologically, tumor cells, amanged in solid sheets, showed small nuclei without significant atypia and granular eosinophilic cytoplasm. Tumor cells showed strong immunoreacitivity for calcitonin and somatostatin. The serum clacitonin was markedly elevated (268.7 pmol/L, normal range; 0.9-7.6 pmol/L). After resection of the tumor, diarrhea and dyspepsia diappeared, and oral glucose tolerance test showed normal glucose tolerance with normalization of calcitonin.
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Endocrinol Metab : Endocrinology and Metabolism
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