Starling J R, Harris C, Granner D K
Arch Surg. 1978 Mar;113(3):241-3. doi: 10.1001/archsurg.1978.01370150013001.
Medullary carcinoma of the thyroid is unique in that it can often be diagnosed solely on the basis of abnormally high basal serum thyrocalcitonin levels. Two brothers described in this report were found to have normal basal serum thyrocalcitonin levels when examined after another family member died from metastatic medullary carcinoma of the thyroid. Pentagastrin, a synthetic analog of gastrin, was subsequently administered to these two high-risk relatives and found to stimulate the release of thyrocalcitonin to abnormally high levels. They were found to have occult medullary carcinoma of the thyroid. Eight other first-degree relatives of the deceased patient with normal basal serum thyrocalcitonin levels were screened with pentagastrin and found to have normal stimulated levels of thyrocalcitonin. This report reinforces the need to recognize that medullary carcinoma of the thyroid can be familial and that physicians are obligated to screen asymptomatic kin who are at high risk. We recommend that all susceptible relatives, even if they have normal basal serum thyrocalcitonin levels, undergo the provocative pentagastrin test with repeat annual testing if necessary. In addition, the provocative pentagastrin test can be used to follow up patients who have undergone thyroidectomy.
甲状腺髓样癌的独特之处在于，它常常仅根据基础血清降钙素水平异常升高就能确诊。本报告中描述的两兄弟，在另一名家庭成员死于甲状腺转移性髓样癌后接受检查时，基础血清降钙素水平正常。随后，向这两名高危亲属注射了胃泌素的合成类似物五肽胃泌素，发现它能刺激降钙素释放至异常高水平。他们被发现患有隐匿性甲状腺髓样癌。对已故患者的另外八名基础血清降钙素水平正常的一级亲属进行五肽胃泌素筛查，发现他们的降钙素刺激水平正常。本报告强调了认识到甲状腺髓样癌可能具有家族性的必要性，以及医生有义务对高危无症状亲属进行筛查。我们建议所有易感亲属，即使他们的基础血清降钙素水平正常，也应接受五肽胃泌素激发试验，必要时每年重复检测。此外，五肽胃泌素激发试验可用于对接受甲状腺切除术的患者进行随访。
