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Der Nuklearmediziner 2016; 39(02): 111-119
DOI: 10.1055/s-0042-105316
Immunologische In-Vitro-Diagnostik
© Georg Thieme Verlag KG Stuttgart · New York

Calcitonin-Screening und Stimulationstests

Calcitonin Screening and Stimulation Tests
R. Görges
1   Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen
,
S.-Y. Sheu-Grabellus
2   Pathologisches Institut Recklinghausen, Recklinghausen
,
V. Tiedje
3   Klinik für Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Essen, Essen
,
D. Simon
4   Klinik für Viszeral- und Allgemeinchirurgie, Krankenhaus Bethesda zu Duisburg, Duisburg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
15. Juni 2016 (online)

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Zusammenfassung

Calcitonin (hCt) ist ein vergleichsweise anspruchsvoller Parameter – sowohl hinsichtlich der Probenbehandlung als auch der Interpretation der Laborergebnisse sowie der hieraus zu ziehenden Konsequenzen. Hinsichtlich der Referenzbereiche sollten geschlechtsspezifische Unterschiede berücksichtigt werden. Die Aussagekraft des Kalzium-Stimulationstests zur Abklärung nur mäßig erhöhter hCt-Basalwerte ist derzeit umstritten; hier besteht noch weiterer Bedarf zur Optimierung bzw. Standardisierung der Durchführung und Interpretation der Ergebnisse. Sofern erwogen wird, hCt im Rahmen eines Screenings bei nodulärem Schilddrüsenbefund oder als Tumormarker in der Verlaufskontrolle behandelter medullärer Schilddrüsenkarzinom-Patienten zu bestimmen, müssen einige Rahmenbedingungen sichergestellt sein. Hierzu gehören insbesondere: optimale präanalytische und stabile laborchemische Bedingungen, Etablierung kontrollierter geschlechtsspezifischer Interventionsschwellenwerte, ein Recall-System für Patienten mit zunächst kontrollbedürftigen Werten, die Verfügbarkeit von validierten Stimulationstests im Falle fraglich pathologischer basaler hCt-Werte, Kenntnis möglicher Einflussparameter auf die Messwerte, eigene Expertise hinsichtlich der Besonderheiten des medullären Schilddrüsenkarzinoms (MTC) und die enge interdisziplinäre Kooperation zwischen Nuklearmedizin, Endokrinologie, Chirurgie und Pathologie.

Abstract

Calcitonin (hCT) is a sensitive marker for medullary thyroid cancer, but calcitonin analytics and interpretation can be challenging. Gender-specific reference ranges should be considered. The additional value of calcium stimulation tests is discussed controversially; there is still need for methodical optimization, standardization and interpretation. When hCt measurement is performed in diagnostic work-up of nodular thyroid disease or as tumor marker in MTC patients, several aspects need to be considered: optimal pre-analytical methods, stable laboratory conditions, gender-specific cut-offs for intervention, recall system for outpatients with abnormal hCT results, knowledge of confounding factors of hCT analytics and special expertise in MTC management. Moreover, interdisciplinary cooperation between nuclear medicine, endocrinology, surgery and pathology is mandatory.

Schlüsselwörter

Calcitonin - Calcitonin-Screening - Stimulationstests - Schilddrüsenknoten - medulläres Schilddrüsenkarzinom

Key words

calcitonin - calcitonin screening - stimulation tests - thyroid nodules - medullary thyroid carcinoma
 

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