Download PDF
Exp Clin Endocrinol Diabetes 2010; 118(8): 520-523
DOI: 10.1055/s-0029-1231083
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Differentiation between Thyroidal and Ectopic Calcitonin Secretion in patients with Coincidental Thyroid Nodules and Pancreatic Tumors – A Report of Two Cases

R. Schneider 1 , A. E. Heverhagen 1 , R. Moll 2 , D. K. Bartsch 1 , K. Schlosser 1
  • 1Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Germany
  • 2Department of Pathology, Philipps University Marburg, Germany
Further Information

Publication History

received 09.05.2009

first decision 07.06.2009 accepted 22.06.2009

Publication Date:
18 August 2009 (online)

Also available at
    Permissions and Reprints

Abstract

Although elevated blood levels of calcitonin are considered highly indicative for the presence of medullary thyroid carcinomas, they may be observed in patients with chronic kidney disease or in consequence of ectopic calcitonin production. We report two patients who presented with excessively elevated calcitonin levels. Diagnostic work-up revealed a single thyroid nodule and a pancreatic tumor with ectopic calcitonin secretion in both of them. On the basis of these case reports, the diagnostic work flow and management in case of clearly elevated calcitonin levels are described and discussed.

Key words

calcitonin - pancreatic endocrine tumor - secondary hyperparathyroidism - medullary thyroid carcinoma - chronic kidney disease

References

  • 1 Hirsch PF, Lester GE, Talmage RV. Calcitonin, an enigmatic hormone: does it have a function?.  J Musculoskel Neuron Interact. 2001;  1 299-305
    PubMedGoogle Scholar
  • 2 Constante G, Meringolo D, Durante C. et al . Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules.  J Clin Endocrinol Metab. 2007;  92 450-455
    PubMedGoogle Scholar
  • 3 Pacini F, Schlumberger M, Dralle H. et al . , The European Thyroid Cancer Taskforce Consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium.  Eur J Endocrinol. 2006;  154 787-803
    CrossrefPubMedGoogle Scholar
  • 4 Roman SA, Mehta P, Sosa JA. Medullary thyroid cancer: early detection and novel treatments.  Curr Opin Oncol. 2008;  21 5-10
    PubMedGoogle Scholar
  • 5 Mullerpatan PM, Joshi SR, Shah RC. et al . Calcitonin-secreting tumor of the pancreas.  Dig Surg. 2004;  21 321-324
    CrossrefPubMedGoogle Scholar
  • 6 Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors.  Gastroenterology. 2008;  135 1469-1492
    CrossrefPubMedGoogle Scholar
  • 7 Öberg K, Eriksson B. Endocrine tumors of the pancreas.  Best Pract Res Clin Gastroenterol. 2005;  19 753-781
    CrossrefPubMedGoogle Scholar
  • 8 Jensen RT, Norton JA. Management of metastatic pancreatic endocrine tumors. In Feldman M, Scharschmidt BF, Sleisener MH (eds) Gastrointestinal and Liver Disease. Philadelphia, Saunders 1998 p 871
    PubMedGoogle Scholar
  • 9 Weil C. Gastroenteropancreatic endocrine tumors.  Klin Wochenschr. 1985;  63 433-459
    CrossrefPubMedGoogle Scholar
  • 10 Eskens FA, Roclofs EJ, Hermus AR. et al . Pancreatic islet cell tumor producing vasoactive intestinal peptide and calcitonin.  Anticancer Res. 1997;  17 4667-4670
    PubMedGoogle Scholar
  • 11 Howard JM, Gohara AF, Cardwell RJ. Malignant islet cell tumor of the pancreas associated with high plasma calcitonin and somatostatin levels.  Surgery. 1989;  105 227-229
    PubMedGoogle Scholar
  • 12 Manche A, Wood SM, Adrian TE. et al . Pancreatic polypeptide and calcitonin secretion from a pancreatic tumor-clinical improvement after hepatic artery embolization.  Postgrad Med J. 1983;  59 313-314
    CrossrefPubMedGoogle Scholar
  • 13 Marty-Double C, Balmes P, Pignodel C. et al . Carcinoma of the pancreas with amyloid stroma and calcitonin secretion: Ultrastructural study.  Ann Pathol. 1981;  1 99-101
    PubMedGoogle Scholar
  • 14 Asa SL, Kovacs K, Killinger DW. et al . Pancreatic islet cell carcinoma producing gastrin, ACTH, alpha-endorphin, somatostatin, and calcitonin.  Am J Gastroenterol. 1980;  74 30-35
    PubMedGoogle Scholar
  • 15 Kaassis M, Duquenne M, Croue A. et al . Calcitonin-secreting neuroendocrine carcinoma of the pancreas with splenic invasion and paraneoplastic hypercalcaemia.  Presse Med. 2001;  30 24
    PubMedGoogle Scholar
  • 16 Machens A, Haedecke J, Hinze R. et al . Hypercalcitoninemia in a sporadic asymptomatic neuroendocrine tumor of the pancreatic tail.  Dig Surg. 2000;  17 522-524
    CrossrefPubMedGoogle Scholar
  • 17 Fleury A, Flejou JF, Sauvanet A. et al . Calcitonin-secreting tumors of the pancreas: About six cases.  Pancreas. 1998;  16 545-550
    CrossrefPubMedGoogle Scholar
  • 18 Delis S, Bakoyiannis A, Giannakou N. et al . Asymptomatic calcitonin-secreting tumor of the pancreas – a case report.  JOP. 2006;  7 70-73
    PubMedGoogle Scholar
  • 19 Raue F, Zinke A, Scherübl H. Regulation of calcitonin secretion and calcitonin gene expression.  Recent Results in Cancer Research. 1992;  125 1-18
    PubMedGoogle Scholar
  • 20 Calmettes C, Chaventre A, Feingold N. et al . Screening for medullary thyroid cancer in France. A national effort.  Henry Ford Hosp Med J. 1989;  37 120-121
    PubMedGoogle Scholar
  • 21 Cheung KC, Roman SA, Wang TS. et al . Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis.  J Clin Endocrinol Metab. 2008;  93 2173-2180
    CrossrefPubMedGoogle Scholar
  • 22 Pacini F, Fontanelli M, Fugazzola L. et al . Routine measurement of serum calcitonin in nodular thyroid disease allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma.  J Clin Endocrinol Metab. 1994;  78 826-829
    CrossrefPubMedGoogle Scholar
  • 23 Rieu M, Lane MC, Richard A. et al . Prevalence of sporadic medullary thyroid carcinoma. The importance of routine measurements of serum calcitonin in the diagnostic evaluation of thyroid nodules.  Clin Endocrinol. 1995;  42 453-460
    CrossrefPubMedGoogle Scholar
  • 24 Vierhapper H, Raber W, Biegelmayer C. et al . Routine measurements of plasma calcitonin in nodular thyroid diseases.  J Clin Endocrinol Metab. 1997;  82 1589-1593
    CrossrefPubMedGoogle Scholar
  • 25 Cheung KC, Roman SA, Wang TS. et al . Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis.  J Clin Endocrinol Metab. 2008;  93 2173-2180
    CrossrefPubMedGoogle Scholar
  • 26 Roman SA, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma.  Cancer. 2006;  107 2134-2142
    CrossrefPubMedGoogle Scholar
  • 27 Lamp EJ, Heddle RM, Ellis A. Spuriously elevated plasma calcitonin in a patient with a thyroid nodule not associated with medullary thyroid carcinoma.  Postgrad Med J. 1999;  75 289-291
    PubMedGoogle Scholar
  • 28 Demers LM, Spencer CA. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease.  Thyroid. 2003;  13 4-126
    CrossrefPubMedGoogle Scholar
  • 29 Vitale G, Ciccarelli A, Caraglia M. et al . Comparison of two provocative tests for calcitonin in medullary thyroid carcinoma: omeprazole vs calcitonin.  Clinical Chemistry. 2002;  48 1505-1510
    PubMedGoogle Scholar
  • 30 Iacobone M, Niccoli-Sire P, Sebag F. et al . Can sporadic medullary thyroid carcinoma be biochemically predicated? Prospective analysis of 66 operated patients with elevated serum calcitonin levels.  World J Surg. 2002;  26 886-890
    CrossrefPubMedGoogle Scholar
  • 31 Leboulleux S, Baudin E, Travagli JP. et al . Medullary Thyroid Carcinoma: Secretory Products. http://www.medscape.com/viewarticle/489038_5
    PubMed
  • 32 Lissak B, Baudin E, Cohen R. et al . Pentagastrin testting in patients with renal insufficiency: normal responsivity of mature calcitonin.  Thyroid. 1998;  8 265-268
    CrossrefPubMedGoogle Scholar
  • 33 Kotzmann H, Schmidt A, Scheuba C. et al . Basal calcitonin levels and response to pentagastrin stimulation in patients after kidney transplantation or on chronic hemodialysis as indicators of medullary carcinoma.  Thyroid. 1999;  9 943-947
    CrossrefPubMedGoogle Scholar
  • 34 Niccoli P, Brunet P, Roubicek C. et al . Abnormal calcitonin levels and pentagastrin response in patients with chronic renal failure on maintenance hemodialysis.  Eur J Endocrinol. 1995;  132 75-81
    PubMedGoogle Scholar
  • 35 Felsenfeld AJ, Machado L, Rodriguez M. The relationship between serum calcitonin and serum calcium in hemodialysis patients.  Am J Kidney Dis. 1993;  21 292-299
    PubMedGoogle Scholar
  • 36 Tomita T, Millard DM. C-cell hyperplasia in secondary hyperparathyroidism.  Histopathology. 1992;  21 46974
    PubMedGoogle Scholar
  • 37 Simmons RE, Hjelle JT, Mahoney C. et al . Renal metabolism of calcitonin.  Am J Physiol. 1988;  254 593-600
    PubMedGoogle Scholar
  • 38 Gibson WGH, Peng T, Croker BP. Age associated C-cell hyperplasia in the human thyroid.  Am J Physiol. 1982;  106 388-393
    PubMedGoogle Scholar
  • 39 Guyetant S, Wion-Barbot N, Rousselet M. et al . C-cell hyperplasia associated with chronic lymphocytic thyroiditis.  Hum Pathol. 1994;  25 514-521
    CrossrefPubMedGoogle Scholar
  • 40 Engelbach M, Heerdt S, Görges R. et al . Is there an ectopic secretion of monomeric calcitonin in the human being?.  Arch Surg. 1998;  383 456-459
    CrossrefPubMedGoogle Scholar
  • 41 Ichimura T, Kondo S, Okushiba S. et al . A calcitonin and vasoactive intestinal peptide producing pancreatic endocrine tumor associated with WDHA syndrome.  Int J Gastrointest Cancer. 2003;  33 99-102
    PubMedGoogle Scholar

Correspondence

R. SchneiderMD 

Department of Visceral

Thoracic and Vascular Surgery

Philipps University Marburg

Baldingerstraße

35033 Marburg

Germany

Phone: 0049/6421/586 64 41

Fax: 0049/6421/586 89 95

Email: raschnei@med.uni-marburg.de

      >