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Macronutrients
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Calcitonin is a 32-amino acid linear polypeptide hormone of the thyroid destined to lower blood calcium. Subcutaneous injection of calcitonin is reserved for the treatment of osteoporosis in postmenopausal women. Calcitonin extracted from the ultimobranchial glands of salmon is the most common in therapeutic uses (36–38, 42).
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Salmon calcitonin, which has a higher potency than human calcitonin, is used clinically. Initial indications were for the treatment of hypercalcemia (for example, in patients with a malignancy and bone metastases) and to increase the calcium content of bones in patients with Paget’s disease and osteoporosis. However, when used for these reasons, an analgesic effect was also observed.
Thyroid cancer
Published in Pallavi Iyer, Herbert Chen, Thyroid and Parathyroid Disorders in Children, 2020
Care should be taken in interpreting calcitonin concentrations in infants and young children as calcitonin is normally elevated in children younger than 3 years of age (5). The definitive therapy for MTC is surgical resection prior to the tumor invading the thyroid capsule. In children with MEN 2A, if preoperative calcitonin <30 pg/mL and the tumor is sub-centimeter, then lymph node metastases is not expected. In MEN 2B, total thyroidectomy with lymph node dissection under care of a high-volume surgeon should be performed within the first few months of life with care given to preserving the parathyroid glands. In children with de novo mutation with MEN 2B, recognition of disease on average is made around 14 years of age by which time there is disseminated disease. If, due to local aggressive metastasis, incomplete surgery is performed, external beam radiotherapy can be considered, but overall prognosis in these patients is still poor (6) (Table 7.1).
Neuroendocrine tumor with diarrhea: not always the usual suspects – a case report of metastatic calcitoninoma with literature review
Published in Acta Clinica Belgica, 2021
Kenny Vlaemynck, Marc De Man, Kathia De Man, Anne Hoorens, Karen Geboes
We describe a case of refractory diarrhea caused by a metastatic calcitoninoma, a rare pancreatic neuroendocrine neoplasm (PanNEN). Calcitonin is a peptide hormone, secreted by the parafollicular C cells of the thyroid and acting as an antagonist of parathormone. Elevated serum calcitonin levels may be related to chronic renal disease or hyperparathyroidism, both causing hypercalcemia, but also raise suspicion of a medullary thyroid carcinoma. The latter is highly unlikely in our case because of TTF1 negativity and absence of thyroid abnormalities on both functional and non-functional imaging. Occasionally, calcitonin may be secreted by other NETs such as pheochromocytomas, lung carcinomas and pancreatic NETs [1]. Nonthyroidal cancers should be excluded, even in the presence of thyroid nodules, especially when these have few suspicious features [2]. A retrospective study of NETs showed that high calcitonin levels (>100 pg/mL) were predominantly found in pancreatic and lung NETs. This was not associated with worse survival, but can be useful as a tumor marker. There was no association with MEN1 syndrome. All patients had synchronous metastases, mostly in the liver or bones [3,4].
Treatment approach for primary hyperparathyroidism in pregnancy
Published in Baylor University Medical Center Proceedings, 2021
Azka Latif, Alheli Arce Gastelum, Kinaan Farhan, Sunil Jagadesh, Sangeeta Mutnuri
The first patient, a 40-year-old woman originally from Sudan, presented for her prenatal visit at 30 weeks’ gestation with a 2-day history of epigastric pain, nausea, and vomiting. Pertinent physical examination, laboratory, and radiological investigations are shown in Table 1. The elevated serum parathyroid hormone level, hypercalcemia, high urinary calcium excretion, and presence of a parathyroid adenoma led to a diagnosis of PHPT and hypercalcemia-induced pancreatitis. Initial medical treatment included intravenous hydration, two doses of calcitonin (300 units), and cinacalcet 15 mg (the patient did not tolerate a higher dose). Despite 5 days of therapy, calcium levels stayed elevated. Therefore, a decision was made to proceed with a right inferior parathyroidectomy. Postoperatively, the patient’s stay was uneventful, and she was discharged on calcium carbonate 1000 mg daily. The serum calcium level slowly normalized and 2 weeks later it was 9 mg/dL. Six weeks after this hospitalization, she gave birth via spontaneous vaginal delivery to a female newborn who was reported to be healthy and doing well.
Primary hyperparathyroidism presenting as severe hypercalcemia with acute pancreatitis in pregnancy
Published in Gynecological Endocrinology, 2020
S. Bansal, R. M. Kaushik, R. Kaushik, S. Modi, S. Raghuvanshi, A. Kusum
The efficacy and safety of different modes of medical management for PHPT in pregnancy are mostly undetermined. Only hydration and calcitonin are considered as safe treatments so far [22], although both have temporary lowering effect on serum calcium [5]. Biphosphonates bring down serum calcium levels by inhibiting bone resorption and decreasing calcium release [23]. Among biphosphonates, zoledronic acid (ZA) is available for treatment of hypercalcemia while pamidronate can be used when ZA is not available. ZA is preferred to pamidronate due to its higher potency [24] and requirement of a shorter time period for administration. Biphosphonates are generally not recommended during pregnancy as they cross the placenta and have been related to a small decrease in gestational age and birthweight and hyper or hypocalcemia of the newborn without any long-term maternal or neonatal adverse effects [25]. Bisphosphonates should only be used in emergencies as a short-term measure before surgery [26].