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Diagnosis of Occult Familial Medullary Carcinoma of the Thyroid Using Pentagastrin
James R. Starling, MD;
Curtis Harris, MD;
Daryl K. Granner, MD
Arch Surg. 1978;113(3):241-243.
Abstract
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• 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.
(Arch Surg 113:241-243, 1978)
Author Affiliations
From the Departments of Surgery (Dr Starling) and Medicine (Drs Harris and Granner), Division of Endocrinology, University of Iowa Medical Center and Veterans Administration Hospital, Iowa City. Dr Starling is presently at the Department of Surgery, University of Wisconsin Hospitals, Madison.
Footnotes
Accepted for publication Sept 6, 1977.
Reprint requests to Department of Surgery, University of Wisconsin Hospital, 1300 University Ave, Madison, WI 53706 (Dr Starling).
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