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Clinical Chemistry 48: 1505-1510, 2002;
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(Clinical Chemistry. 2002;48:1505-1510.)
© 2002 American Association for Clinical Chemistry, Inc.

Comparison of Two Provocative Tests for Calcitonin in Medullary Thyroid Carcinoma: Omeprazole vs Pentagastrin

Giovanni Vitale1, Antonio Ciccarelli1, Michele Caraglia2, Maurizio Galderisi3, Riccardo Rossi1, Salvatore Del Prete4, Alberto Abbruzzese2 and Giovanni Lupoli1a

1 Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy.

2 Dipartimento di Biochimica e Biofisica "F. Cedrangolo", Seconda Università di Napoli, 80138 Naples, Italy.

3 Cattedra di Medicina d’Urgenza, Istituto di Medicina e Clinica Sperimentale, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy.

4 Unità Operativa di Oncologia, Ospedale "S. Giovanni di Dio", 80027 Frattamaggiore (NA), Italy.

aAddress correspondence to this author at: Via E. Nicolardi 145, P.co Arcadia 8, 80131 Naples, Italy. Fax 39-81-7462427; e-mail Lupoli{at}unina.it.

Background: Provocative tests for calcitonin (CT) are fundamental in the diagnosis and follow-up of C-cell disease and in the detection of hereditary medullary thyroid carcinoma (MTC) carriers with unknown RET mutations. A recent report has proposed omeprazole, which can increase endogenous gastrin (GT), as a new provocative test for MTC.

Methods: We compared the omeprazole test (20 mg twice a day for 4 days) to the pentagastrin test (0.5 µg/kg of body weight) for the diagnosis and management of MTC. Twenty healthy individuals and 20 MTC patients with mildly or moderately increased basal CT serum concentrations underwent the pentagastrin and omeprazole tests.

Results: In MTC patients, the pentagastrin test produced a significantly higher increase in serum CT than did omeprazole. After the pentagastrin injection, several patients reported unpleasant side effects, including substantial tightness in 38 of 40 participants. No adverse effects were observed during the omeprazole test. A significant direct correlation was recorded between CT% (ratio of CT peak to basal value x 100) and GT% (ratio of GT peak to basal value x 100) during the omeprazole test in MTC patients (r = 0.73; P <0.001).

Conclusions: In spite of several adverse effects, pentagastrin remains the best provocative test for the diagnosis of MTC. Omeprazole may be useful when pentagastrin is contraindicated or refused because of the unpleasant side effects, but further validation is needed.






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