Macrocalcitonin Is a Novel Pitfall in the Routine of Serum Calcitonin Immunoassay

Macrocalcitonin Is a Novel Pitfall in the Routine of Serum Calcitonin Immunoassay

Author Alves, Thalita G. Autor UNIFESP Google Scholar
Kasamatsu, Teresa S. Autor UNIFESP Google Scholar
Yang, Ji H. Autor UNIFESP Google Scholar
Meneghetti, Maria Cecilia Z. Autor UNIFESP Google Scholar
Mendes, Aline Autor UNIFESP Google Scholar
Kunii, Ilda S. Autor UNIFESP Google Scholar
Lindsey, Susan C. Autor UNIFESP Google Scholar
Camacho, Cleber P. Autor UNIFESP Google Scholar
Dias da Silva, Magnus R. Autor UNIFESP Google Scholar
Maciel, Rui M. B. Autor UNIFESP Google Scholar
Vieira, Jose Gilberto H. Autor UNIFESP Google Scholar
Martins, Joao Roberto M. Autor UNIFESP Google Scholar
Abstract Context: Calcitonin (CT) is a sensitive marker of medullary thyroid carcinoma (MTC) and is used for primary diagnosis and follow-up after thyroidectomy. However, persistently elevated CT is observed even after complete surgical removal without evidence of a recurrent or persistent tumor. Objective: To investigate the presence of assay interference in the serum CT of MTC patients who are apparently without a structural disease. Patients and Methods: We studied three index MTC cases for CT assay interference and 14 patients with metastatic MTC. The CT level was measured using an immunofluorometric assay. Screening for assay interference was performed by determination of CT levels before and after serum treatment with polyethylene glycol. Additionally, samples were analyzed by chromatography on ultra-performance liquid chromatography and protein A-Sepharose. Results: Patients with biochemical and structural disease showed CT mean recovery of 84.1% after polyethylene glycol treatment, whereas patients suspected of interference showed recovery from 2-7%. The elution profile on UPLC showed that the immunometric CT from these three patients behaved like a high molecular mass aggregate (>300 kDa). Additionally, when these samples were applied to the protein A-Sepharose, CT immunoreactivity was retained on the column and was only released after lowering the pH. Conclusions: For the first time, our results show the presence of a novel pitfall in the CT immunoassay: "macrocalcitonin." Its etiology, frequency, and meaning remain to be defined, but its recognition is of interest and can help clinicians avoid unnecessary diagnostic investigations and treatment during the follow-up of MTC.
xmlui.dri2xhtml.METS-1.0.item-coverage Washington
Language English
Sponsor Sao Paulo State Research Foundation-FAPESP
Federal Agency of Support and Evaluation of Postgraduate Education (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior)
National Council for Scientific and Technological Development
Grant number FAPESP: 2006/60402-1
FAPESP: 2010/51547-1
FAPESP: 2010/19478
Date 2016
Published in Journal Of Clinical Endocrinology & Metabolism. Washington, v. 101, n. 2, p. 653-658, 2016.
ISSN 0021-972X (Sherpa/Romeo, impact factor)
Publisher Endocrine Soc
Extent 653-658
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000378642700035

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