Коллега, я с третьей попытки всё же спрошу прямо: почему Вы не расскажете о пациентке как положено?
Почему консультанты должны гадать, нет ли там наследственности специфической? И не пьёт ли она омепразол? И не страдает ли тяжелым панкреатитом? И нет ли выраженного снижения функции почек? И что там, наконец (хотя логичнее, подчеркну, с этого начинать), с описанием УЗИ (какое есть) и пункцией? Usw.
Оценка уровней кальцитонина бывает сложна - посмотрите европейские [Ссылки доступны только зарегистрированным пользователям ] к прошлой версии американских рекомендаций:
Цитата:
To distinguish these situations, subjects with elevated basal serum Ct should be submitted to a stimulation test which should clarify the origin of the detected Ct, especially when the basal value is low-mild elevated (i.e. between 10 and 100 pg/ml). The Ct deriving from MTC usually increases 3-4 times above the basal value after stimulation while artifactual Ct values due to technical problems or serum Ct produced by non thyroid cells usually do not increase after stimulation (Figure 1). Until few years ago the Ct stimulation test was performed with the injection of pentagastrin (Pg) (Peptavlon, Nova Laboratories, LTD, Leichester U,K 0.5 mg/kg ev) and this represented a very important limit for American colleagues because Pg was, and still is, unavailable in USA. Recently, it has been clearly demonstrated that a similar and even stronger stimulation can be obtained with a rapid infusion of calcium (2.3 mg/Kg of calcium ion or 25 mg/Kg of calcium gluconate) [16-19]. Thus, with the possibility to use calcium infusion instead of pentagastrin this limit has been overcome but it is still unresolved the problem of the stimulated Ct operative cut-off. There are several studies in which it has been attempted to clarify this issue [20-22]. However, while approaching this issue it is important to take into account that also normal subjects can have a positive response of serum Ct after stimulation but it never increases over 60 pg/ml [ng/L][17], thus a stimulated Ct between 60 and 100 pg/ml is a grey zone that deserves to be monitored. Furthermore, the rate of increase should also be considered and the clinicians should be aware that only a 3-4 time increase of stimulated Ct with respect to basal Ct should be considered as a positive response [23]. On this regard it is useful to say that these considerations are valid for sporadic cases of suspected MTC while when a hereditary case is under investigation any level of increase of either basal or stimulated Ct should be considered as positive [24].
26.07.2015, 17:52
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