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Calcitonin measurement in pediatrics: reference ranges are gender-dependent, validation in medullary thyroid cancer
Felix Eckelt1, Mandy Vogel2, Mandy Geserick2
1Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital of Leipzig, Leipzig, Germany.
Insights
New research establishes pediatric reference ranges for calcitonin (CT) levels, crucial for diagnosing multiple endocrine neoplasia type 2 (MEN 2) and monitoring medullary thyroid carcinoma (MTC) in children. CT levels are age- and gender-dependent in this population.
Area of Science:
- Pediatric Endocrinology
- Clinical Chemistry
- Laboratory Medicine
Background:
- Limited data exists on serum calcitonin (CT) reference ranges in pediatric populations.
- Accurate age- and gender-specific CT ranges are essential for diagnosing multiple endocrine neoplasia type 2 (MEN 2) and managing medullary thyroid carcinoma (MTC).
- Establishing these ranges aids in evaluating treatment success and identifying disease recurrence in children.
Purpose of the Study:
- To determine age- and gender-dependent serum calcitonin (CT) reference ranges in a pediatric cohort.
- To provide validated diagnostic tools for pediatric patients with MEN 2 and thyroid conditions.
- To assess the influence of thyroid diseases on CT levels in children.
Main Methods:
- Analysis of 6090 serum samples from 2639 healthy children aged 1 month to 17.9 years using electrochemiluminescence immunoassay (ECLIA).
- Estimation of reference intervals using the LMS method.
- Clinical validation involved analyzing samples from patients with MEN 2 and other thyroid diseases.
Main Results:
- Serum CT levels demonstrated significant age- and gender-dependence, with higher levels observed in boys.
- A rapid decrease in CT levels was noted from infancy to ages 4-5 years in both sexes.
- Thyroid diseases had a minimal impact on CT levels in the pediatric cohort, with only 1.5% showing elevated levels.
Conclusions:
- This study provides the largest dataset for establishing novel pediatric calcitonin reference ranges.
- The findings enable precise laboratory monitoring of CT in pediatric patients, particularly those with MEN 2.
- The established reference ranges are vital for accurate diagnosis and management of endocrine and thyroid-related conditions in children.
Background:
There is only limited information on serum reference ranges of calcitonin (CT) in infants, children and adolescents. This gap hampers valid diagnostics in patients with multiple endocrine neoplasia type 2 (MEN 2) and planned prophylactic thyroidectomy. In addition, age-dependent reference ranges for CT are necessary to define a cure in medullary thyroid carcinoma (MTC). We asked whether the reference ranges for CT levels were age- and gender-dependent in the serum of a pediatric cohort.
Methods:
A total of 6090 serum samples of 2639 subjects of the LIFE-Child cohort aged between 1 month and 17.9 years were analyzed by the CT electrochemiluminescence immunoassay (ECLIA). Reference intervals were estimated using the LMS method. For clinical validation the serum of 28 patients (61 samples) with MEN 2 and 106 patients (136 samples) with thyroid diseases were analyzed.
Results:
CT levels showed a clear age- and gender-dependence with significantly higher values in boys (p<0.01). An accelerated decline of CT levels from newborn to children at the age of 4 and 5 years was observed for both sexes. A cure for MTC was demonstrated in 71% of MEN 2 patients after thyroidectomy, whereas 5 patients remained suspicious for micrometastasis or relapse. Only 1.5% of our patients with thyroid diseases revealed increased CT levels.
Conclusions:
This is the largest study to establish novel pediatric reference ranges from the CT values of healthy subjects. It allows a precise laboratory monitoring of CT in pediatric patients with MEN 2. Thyroid diseases did not have a relevant influence on CT levels in our pediatric cohort.
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