Charles F. Moore

Calcitonin in extrathyroidal tissues of man.

Prior studies have demonstrated detectable immunoreactive calcitonin in the serum and urine of totally thyroidectomized humans, suggesting that the hormone may be secreted by extrathyroidal tissues. Accordingly, a study of the immunoreactive calcitonin content of human tissues was undertaken, utilizing autopsy material from 23 patients. Significant amounts of calcitonin were found in many extrathyroidal tissues, ranging up to 40 ng/g wet weight. The hormone was detectable with two antibodies having different region specificities for calcitonin. Gel filtration and subsequent radioimmunoassay demonstrated that extrathyroidal tissue has calcitonin fractions of the same molecular size and charge characteristics as do the serum and thyroid. The finding of large amounts of extrathyroidal calcitonin may explain why thyroidectomy in man is not accompanied by marked changes in calcium metabolism.

The infrequency of hypercalcemia in sarcoidosis.

Abstract For many years hypercalcemia has been considered to be a rather common complication of sarcoidosis. More recently, the serum ionized fraction has been reported to be commonly elevated. These findings, combined with earlier reports of the frequent occurrence of hypercalciuria, have led to the conclusion that disorders of calcium metabolism may be a basic feature of sarcoidosis. In the present analysis measurement of total and ultrafiltrable serum calcium levels in a prospective study of 137 patients with sarcoidosis revealed no significant differences in mean values between patients and controls. Six patients had hypercalcemia at the time of initial sampling, but five were normal on subsequent examinations. Retrospective analysis of 243 other patients with sarcoidosis who had serum calcium measurements in the routine hospital laboratory between 1960 and 1968 revealed significant hypercalcemia in seven instances. In neither the prospective nor retrospective studies were serum calcium levels increased during the summer months. Thus, persistent hypercalcemia was observed in eight of 364 patients (2.2 per cent) and only in association with severe and widespread sarcoidosis. Total and ultrafiltrable magnesium and serum phosphate levels were normal. The association of hypercalcemia with severe and disseminated sarcoidosis, the current widespread use of corticosteroids in patients with progressive illness, and the suppressive effects of these agents on sarcoid granulomatosis, best explain the infrequency with which hypercalcemia is encountered in recent studies of this disease.

Immunochemical heterogeneity of calcitonin in man: effect on radioimmunoassay.

Determinations of blood levels of human calcitonin by radioimmunoassay have varied considerably in different laboratories. Much of the controversy over calcitonin levels can be attributed to the multiplicity of immunoreactive forms of the hormone (iCT), the differing region specificities of the antisera utilized for measurement by radioimmunoassay, protein effects, different rates of degradation of the various iCT fractions and the specific methodology of the radioimmunoassay.

Calcitonin as a marker for bronchogenic cancer. A prospective study

A prospective study was done of serum calcitonin (HCT) levels in 61 patients with bronchogenic cancer. Initially, 52% of patients had hypercalcitonemia. Hypercalcitonemia was not confined to patients with any particular histologic type. Seventy‐eight percent of those with high calcitonin remained normocalcemic. There was no correlation between high calcitonin levels and osseous metastases. Selective thyroid venous sampling delineated two types of hypercalcitonemia: thyroidal and ectopic. To date, the ectopic type has been associated with the small cell bronchogenic carcinoma. High initial calcitonin levels decreased significantly in 75% of patients on antitumor therapy. In 13 evaluable patients calcitonin levels mirrored clinical status changes 67% of the time. Calcitonin may be a useful marker to assess the results of therapy in patients with bronchogenic cancer. Cancer 44:680‐684, 1979.

Calcitonin in thyroidectomized patients.

Hypothyroid patients with total or near-total thyroidectomy were found to have detectable immunoreactive calcitonin in the serum and urine. These findings suggest that human calcitonin may be secreted by extrathyroidal tissues.

Calcitonin Levels in Chronic Renal Disease

High levels of serum calcitonin were found in patients with chronic renal failure. Serum calcitonin correlated directly with the phosphate to total calcium ratio; calcitonin levels correlated inversely with serum calcium in those patients on dialysis and directly with serum calcium in nondialysis patients. All patients had elevated serum gastrin. The high levels of serum calcitonin usually decreased following successful kidney transplantation. The pathophysiology of this hypercalcitonemia and its relationship to renal osteodystrophy and the disordered calcium metabolism of uremia remains to be elucidated.

Serum urate in healthy men. Intermittent elevations and seasonal effect.

EPIDEMIOLOGIC surveys of serum mate levels have been interpreted to indicate that multiple factors,1 , 2 including race,3 , 4 social stratum,5 , 6 intelligence,7 , 8 and stress,9 , 10 influence the...

Effect of Streptozotocin-induced Diabetes on Pancreatic Insulin Content of the Fetus

Diabetes was produced in five-day pregnant Sprague- Dawley rats by intravenous injection of 40 mg./kg. body weight of streptozotocin. Normal pregnant rats were used as controls. Pancreases of the mothers and their offsprings were extracted by acid-alcohol and the insulin measured by immunoassay using rat insulin as a standard. Nonfasting blood sugar of the streptozotocin-treated pregnant rats was 285 ± 18 mg./100 ml. and their pancreatic insulin concentration was 5.9 ± 1 μg./gm. compared to 103 ± 3 mg./100 ml. and 44.2 μg./gm., respectively, in the normal rats. Fetal pancreases of streptozotocin-induced diabetic pregnant rats and normal animals were obtained on Days 18, 19, and 21 of gestation, and on Day 4 after birth. The pancreatic insulin concentration of fetuses of diabetic mothers rapidly and progressively increased from 8.0 ± 0.9 μg./gm. on Day 18 to a peak of 63.0 ± 9.0 /μg./gm. on Day 21. On Day 4 after birth, the value was 312 ± 109 μg./gm. The total pancreatic insulin content also progressively increased to a prenatal peak of 0.84 ± 0.15 μg. on Day 21. The pancreatic insulin concentration of fetuses of normal mothers was not significantly different from those of diabetic mothers. There was no correlation between the elevation of maternal blood sugar and the insulin concentration of the fetal pancreas. The total pancreatic insulin content of fetuses of diabetic rats was less than those offspring of the normal rats on Day 18 and Day 4 after birth, but was not significantly different on Days 19 and 21. The lower insulin content found in fourday-old rats born of diabetic animals was probably related to their inability to obtain adequate nourishment from their very sick mothers.

Sarcoidosis and hyperparathyroidism

Abstract This patient presented with hypercalcemia and widespread sarcoidosis and was subsequently found to have a parathyroid adenoma. The clinician, when confronted by a patient who has hypercalcemia and a disease known to produce this abnormality such as sarcoidosis, should consider the possibility of coexistent hyperparathyroidism. In the absence of parathyroid bone disease, this diagnosis must be based on a judicious evaluation of selected laboratory procedures. The merits and limitations of some of these tests, as they pertain to sarcoidosis and hyperparathyroidism, are discussed, and the previously reported cases of coexistent sarcoidosis and hyperparathyroidism are summarized.

Urine calcitonin as a test for medullary thyroid cancer: a new screening procedure.

Although the radioimmunoassay of serum calcitonin (CT) has facilitated the diagnosis of medullary thyroid cancer (MTC) one may encounter patients whose basal serum levels of CT are normal or nearly normal. In such cases clinicians have utilized intravenous stimulation tests such as calcium or penta-gastrin to obtain a diagnostic increase in serum CT. We have reported finding immunorcactive CT in the urine of man and have found it to be a useful technique for the diagnosis and study of patients at risk for MTC or other hypercalcitonemic diseases. Using basal urine CT alone we were able to separate 73% of patients at risk for MTC into clearly normal or abnormal groups. For the remaining 27% a stimulation test with subsequent determination of urine CT was required. The radioimmunoassay of urine CT is a simple, reliable, accurate test for the screening diagnosis of MTC. A protocol for the screening workup of a patient at risk for MTC is given.