Kruse K, Süss A, Büsse M, Schneider P
J Pediatr. 1987 Jul;111(1):57-63. doi: 10.1016/s0022-3476(87)80342-6.
Decreased basal and calcium-stimulated calcitonin serum levels have been found in children with congenital hypothyroidism and in those receiving anticonvulsant drugs. The purpose of our investigation was to confirm these results using a new technique for calcitonin measurement and to study the effect on bone turnover. Calcitonin serum levels were measured with two different antibodies before and after a low-dose Ca infusion in patients receiving phenytoin, primidone, carbamazepine, or valproate and in patients with congenital hypothyroidism receiving L-thyroxine. In comparison with control values, basal and Ca-stimulated extractable calcitonin, representing the monomeric and biologically active form of the hormone, were moderately decreased in patients with epilepsy receiving phenytoin and primidone, and severely decreased in patients with hypothyroidism. Ca and bone metabolism were normal, except for an elevated renal threshold for phosphate (indicating phosphate conservation) in patients receiving phenytoin and primidone, and increased fasting urinary excretion of Ca and hydroxyproline (indicating increased bone resorption) in patients with hypothyroidism. The secretory capacity of the C cells for monomeric calcitonin is decreased in children receiving treatment with some, but not all, anticonvulsant drugs, and lacking in patients with hypothyroidism. Patients with calcitonin deficiency may be prone to osteopenia if the tendency to increased osteoclastic activity is aggravated by secondary hyperparathyroidism in patients with epilepsy receiving phenytoin and primidone or by inappropriate thyroid replacement therapy in patients with hypothyroidism.
先天性甲状腺功能减退症患儿以及接受抗惊厥药物治疗的患儿血清降钙素基础水平和钙刺激水平均降低。我们研究的目的是使用一种新的降钙素测量技术来证实这些结果，并研究其对骨转换的影响。在接受苯妥英钠、扑米酮、卡马西平或丙戊酸盐治疗的患者以及接受左旋甲状腺素治疗的先天性甲状腺功能减退症患者中，在低剂量钙输注前后，用两种不同抗体测量血清降钙素水平。与对照值相比，接受苯妥英钠和扑米酮治疗的癫痫患者中，基础和钙刺激的可提取降钙素（代表该激素的单体和生物活性形式）中度降低，而甲状腺功能减退症患者中则严重降低。除了接受苯妥英钠和扑米酮治疗的患者肾磷酸盐阈值升高（表明磷酸盐潴留）以及甲状腺功能减退症患者空腹尿钙和羟脯氨酸排泄增加（表明骨吸收增加）外，钙和骨代谢正常。接受某些但并非所有抗惊厥药物治疗的儿童中，C细胞分泌单体降钙素的能力降低，而甲状腺功能减退症患者则缺乏这种能力。如果接受苯妥英钠和扑米酮治疗的癫痫患者继发性甲状旁腺功能亢进或甲状腺功能减退症患者甲状腺替代治疗不当加重破骨细胞活性增加的趋势，降钙素缺乏的患者可能易患骨质减少。
