Bestimmung von Kalzitonin

Zusammenfassung

Kalzitonin ist ein vergleichsweise sensitiver, spezifischer und reliabler Tumormarker, der bei der Primärdiagnostik und Nachsorge des C-Zellkarzinoms sowie der neoplastischen C-Zell-Hyperplasie einen zentralen Stellenwert besitzt. Wesentlich seltener wird Kalzitonin auch bei anderen Tumorarten nachgewiesen. Zur Messung sollten immunometrische Two-Site-Assays mit einer funktionellen Sensitivität um 1-2 pg/ml verwendet werden. Assays mit weitgehend selektiver Erfassung der monomeren Kalzitoninform bieten den Vorteil einer höheren Spezifität bezüglich des Erkennens von C-Zellkarzinomen. Unter diesen Voraussetzungen besitzen bereits Messungen des basalen Kalzitonins eine hohe diagnostische Aussagekraft. Die Durchführung eines Pentagastrintests kann die diagnostische Sensitivität und Spezifität der Kalzitoninbestimmung steigern, aber falsch positive Ergebnisse sind auch hierbei insbesondere bei C-Zellhyperplasie und Niereninsuffizienz von klinischer Relevanz. Bezüglich des Screenings der Familienmitglieder von Patienten mit C-Zellkarzinom hat die molekulargenetische Diagnostik in den letzten Jahren den Pentagastrintest weitgehend abgelöst. Als neues Einsatzgebiet rückt derzeit das Kalzitoninscreening bei Struma nodosa stärker in den Blickpunkt. Zwar können hierdurch nur bis 10 % der (ohnehin seltenen) Schilddrüsenmalignome erfasst werden, und bei den empfohlenen Interventionsschwellenwerten wird ein nicht unerheblicher Anteil unnötiger Schilddrüsenoperationen verursacht, aber die Chance kurativer Interventionen durch Erfassung früher Tumorstadien steigt.

Abstract

Calcitonin in serum is a comparatively highly sensitive, specific and reliable tumor marker of central relevance for the diagnosis and follow-up of medullary thyroidal C-cell carcinoma (MTC) and neoplastic C-cell hyperplasia (CCH). It is seen considerably less often in other tumor entities. For determination we recommend immunometric two-site assays of approximately 1-2 pg/ml sensitivity. Higher MTC specificity is achieved by assays focussing on a largely selective determination of monomeric calcitonin. If this is realized, basal calcitonin levels are already greatly relevant for MTC or CCH diagnosis. The diagnostic sensitivity and specificity of calcitonin determination may be further enhanced by means of pentagastrin test, but even then false positive results are clinically relevant especially in benign CCH and renal insufficiency. In family screening in case of MTC patients, moleculargenetic techniques have become the procedure of choice and have now largely replaced the pentagastrin test. Calcitonin screening in adenomatous goitre (struma nodosa) is making headway. Although this accounts for only 10 % of thyroidal malignomas (which are in fact rare), and the recommanded levels of intervention will result in many unnecessary surgical operations, early tumor staging definitely increases the chances for curative intervention.

Kalzitonin - Pentagastrintest - C-Zellkarzinom - Struma nodosa - Screening - Monomer

Calcitonin - pentagastrin test - medullary thyroid carcinoma - adenomatous goitre - screening - monomer

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