@article{41356310d2414c199c2a14e3b7b6073b,
title = "SERUM HISTAMINASE AND CALCITONIN LEVELS IN MEDULLARY CARCINOMA OF THE THYROID",
abstract = "A comparison was made of serumhistaminase activity and calcitonin levels in forty-two patients with localised and metastatic medullary carcinoma of the thyroid. Thirty-three patients were members of families in which the disease was inherited. Half of the patients were found to have abnormally high serum-histaminase activity when compared with sixty-two controls. Twenty-six family members who did not have the disease had serum-histaminase activities within the normal range. Of the patients with metastatic tumour, 70\% had high enzyme activity, with the highest activity in patients with pulmonary metastases. Serum-histaminase activity fell after removal of neck tumour in fourteen out of twenty patients, but did not fall to normal levels in six patients, four of whom had evidence of metastatic tumour. Basal serum-calcitonin levels were measured in thirty-one patients with medullary thyroid carcinoma and were above normal in twenty-nine. Calcitonin fell to low or undetectable levels in all but three of the patients who had neck tumour removed. These results suggest that measurements of serum-histaminase activity may be useful in the search for metastases and the detection of residual tumour after surgery. However, measurement of basal serum-calcitonin levels seems to be a more reliable test for early detection of localised medullary thyroid tumour.",
author = "Baylin, \{S. B.\} and Beaven, \{M. A.\} and Keiser, \{H. R.\} and Tashjian, \{A. H.\} and Melvin, \{K. E.W.\}",
note = "Funding Information: The measurement in serum or urine of tumour- produced substances has proved a very useful way of detecting certain tumours. Examples of tumour- specific products which can be detected in serum or urine are the colonic-embryonic antigen from carci- noma of the bowel,7 oci-fetoglobin and serum- proline-hydroxylase from hepatoma, 8,9 serum and urinary chorionic gonadotrophin from trophoblastic tumours,10, 1 and 5-hydroxyindoleacetic acid from carcinoid.12 Calcitonin z1 and histaminase 1,22 are produced in large amounts by medullary thyroid carcinoma, and measurement of calcitonin in serum is a reliable and sensitive means of early detection of this tumour. 3, s Our findings provide further evidence that some patients with medullary carcinoma of the thyroid have high serum-histaminase activity. There seems to be a correlation between high serum-histaminase activity and metastatic disease. This correlation is true for patients with both familial and sporadic medullary carcinoma of the thyroid. The serum-histaminase activity was especially high in the four patients with pulmonary metastases; however, the number of patients studied has been small, and further observa- tions are necessary to determine whether this finding is of diagnostic significance. Histaminase activity is a specific marker for medul- lary thyroid carcinoma. In fifty-nine patients with a variety of diseases and neoplasms, raised serum- histaminase activity has not been observed, except, possibly, in a woman with metastatic adenocarcinoma of the breast who had a serum activity of 5-6 units per m1.1,23 The only other situations where histaminase activity appears in large amounts in serum is during pregnancy 24,25 and after the injection of heparin. 26, 27 The simultaneous measurement of serum-histami- nase activity and serum-calcitonin levels in patients with medullary thyroid carcinoma has provided addi- tional information about the use of these two markers in determining the extent of the disease. 70\% of the patients with high serum-histaminase activity had evidence of extrathyroidal disease, and most patients with localised disease had serum-histaminase activities within the normal range. All but two patients with medullary carcinoma of the thyroid, however, had raised basal serum-calcitonin levels whether the disease was localised or not. The two patients who did not have clearly elevated basal calcitonin levels showed an exaggerated response in serum-calcitonin to calcium infusion, a test that has been shown to separate clearly patients with early medullary carcinoma from normal subjects. 3 Six patients continued to have high serum-histami- nase activity (table i) after removal of primary tumour even though the basal calcitonin levels returned to normal in some of these patients. The reason why one marker remained high and the other returned to normal is uncertain, but the presence of occult tumour must be suspected in these patients. Indeed, follow- up studies of serum-calcitonin under basal conditions and after calcium infusion have already given definite evidence of the presence of residual tumour in two of these patients. 28 We have shown that raised serum-histaminase activity is an indicator of medullary carcinoma of the thyroid. However, histaminase activity is not always raised in cases of medullary carcinoma, and measure- ment of serum-calcitonin still seems to be the method of choice in screening members of families with a history of thyroid tumours; and measurement of serum-calcitonin levels during calcium infusion is probably the most reliable test for the early detection of this tumour. However, serum-histaminase activity measurements seem to have a useful role in the pre- operative detection of metastatic disease and in the search for residual tumour after thyroidectomy. We thank Miss Barbara G. Howland for expert assistance and Dr. C. S. Hill, of the M. D. Anderson Hospital, Houston, Texas, Dr. C. E. Jackson, of the Henry Ford Hospital, Detroit, Michigan, and other physicians who kindly supplied serum samples for study. This investigation was supported in part by a research grant from the National Institute of Arthritis and Metabolic Diseases (AM 10206). Requests for reprints",
year = "1972",
month = feb,
day = "26",
doi = "10.1016/S0140-6736(72)90120-1",
language = "English (US)",
volume = "299",
pages = "455--458",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier B.V.",
number = "7748",
}