Castagna Maria G, Fugazzola Laura, Maino Fabio, Covelli Danila, Memmo Silvia, Sestini Fausta, Fioravanti Carla, Ferraris Fusarini Chiara, Scapellato Carlo, Macchini Francesco, Cevenini Gabriele, Pacini Furio
Department of Medical, Surgical, and Neurological Sciences (M.G.C., F.M., S.M., F.S., C.F., F.P.), University of Siena, 53100 Siena, Italy; Endocrine Unit (L.F., D.C.), Fondazione Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda, and Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; Clinical Pathology Laboratory (C.F.F.), Fondazione IRCCS Ca'Granda, 20122 Milan, Italy; Laboratory of Clinical Pathology (C.S.), Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; Pediatric Surgery Unit (F.M.), Fondazione IRCCS Ca'Granda, 20122 Milan, Italy; and Department of Surgery and Bioengineering (G.C.), University of Siena, 53100 Siena, Italy.
J Clin Endocrinol Metab. 2015 May;100(5):1780-4. doi: 10.1210/jc.2014-4508. Epub 2015 Mar 12.
Children belonging to the multiple endocrine neoplasia type 2 (MEN 2) pedigree and carrying germline RET mutations are candidates for prophylactic thyroidectomy, the timing of which is based on the mutation-associated risk and the calcitonin (CT) levels.
The aim of this study was to establish the reference range for serum CT in a pediatric population. The study included 2740 subjects (1339 females and 1401 males) ranging in age from 1 day to 16 years and undergoing blood testing for any medical condition not affecting serum CT.
Overall, serum CT was undetectable in 61.5% of the samples and detectable in 38.5%. Detectable samples were more frequent in the first 2 years of life. Thereafter, undetectable samples became more frequent, particularly in females. Mean serum CT concentrations were higher in the first year of life (9.81 ± 8.8 pg/mL; range, 2.0-48.9 pg/mL) and the second year of life (4.56 ± 2.64 pg/mL; range, 2.0-14.7 pg/mL). A significant decrease of serum CT levels was observed thereafter (P < .001), and starting from the third year of life serum CT levels were similar to those found in adults. No gender difference was found in any age group. Based on these results, age-specific CT reference ranges are needed in the pediatric population, and especially in the first 2 years of life.
This is the first study defining the reference range for serum CT in the pediatric population and large enough to be statistically meaningful. Our proposal may facilitate the process of decision making when dealing with gene carriers of MEN 2.
患有2型多发性内分泌腺瘤病（MEN 2）谱系且携带种系RET突变的儿童是预防性甲状腺切除术的候选者，手术时机基于与突变相关的风险和降钙素（CT）水平。
本研究的目的是建立儿科人群血清CT的参考范围。该研究纳入了2740名受试者（1339名女性和1401名男性），年龄从1天至16岁，因任何不影响血清CT的医疗状况接受血液检测。
总体而言，61.5%的样本血清CT检测不到，38.5%的样本可检测到。可检测样本在生命的头2年更为常见。此后，检测不到的样本变得更为常见，尤其是在女性中。生命第一年的平均血清CT浓度较高（9.81±8.8 pg/mL；范围为2.0 - 48.9 pg/mL），第二年为（4.56±2.64 pg/mL；范围为2.0 - 14.7 pg/mL）。此后观察到血清CT水平显著下降（P <.001），从生命第三年开始，血清CT水平与成人相似。各年龄组均未发现性别差异。基于这些结果，儿科人群，尤其是生命的头2年，需要特定年龄的CT参考范围。
这是第一项定义儿科人群血清CT参考范围的研究，样本量足够大，具有统计学意义。我们的提议可能有助于在处理MEN 2基因携带者时的决策过程。
