Clin Endocrinol Metab 40: 738, 1975
HYPERCALCITONINEMIA IN ACUTE PANCREATITIS Daniel D. Canale and Richard K. Donabedian, Department of Laboratory Medicine, Yaie University School of Medicine, New Haven, Connecticut
The traditional explanation of peripancreatic calcium saponfication for the hypocalcemia associated with acute pancreatitis has several shortcomings. First, calcium replacement of equal or greater magnitude than that lost to saponification often fails to restore serum calcium to normal levels (1,2). Second, in the presence of normal parathyroid function, removal of calcium by saponification should be compensated for rapidly by calcium mobilization from bone (3). But, in fact, the hypocalcemia of pancreatitis usually persists for several days. These observations suggest that parathyroid hormone release is impaired or that an antagonist to parathyroid hormone is present. The present study was undertaken to evaluate the possible role of calcitonin in the hypocalcemia of acute pancreatitis. MATERIALS AND METHODS Four patients with acute pancreatitis associated with hypocalcemia were studied. Sera from patients and ten normals were kept at -20°C until assayed, in duplicate, for Immunoreactive calcitonin (iCT) by the method of Deftos (4). Time of storage varied from one week to six months. Stability of iCT for up to six months at -20°C has been demonstrated (4). Rabbit antiserum to human calcitonin was obtained from Cal-Biochem (La Jolia, Calif.). Synthetic human calcitonin obtained by courtesy of Dr.
Dixon, Ciba-Geigy (Summit, N.J.) was used for iodination and for standards. Gel filtration of sera from patients and controls was performed on Sephadex 6-75 at pH 7.4 in Sorenson's buffer. Immunodilution studies on sera from two of the patients were also performed. To determine the possible "damaging" influence of sera from patients with pancreatitis on iCT, sera from two of the patients were incubated for 72 hours with 1 2 5 | labeled synthetic human calcitonin without the addition of antibody to calcitonin. Amyiase, lipase, calcium, phosphate, and albumin were measured according to published methods (5"9). RESULTS AND DISCUSSION Immunoreactive calcitonin values in each of the normals was less than 100 Pg/ml serum, which is in agreement with previously published data (4). This also was the limit of the assay sensitivity. Sera from newborn infants, known to have elevated iCT, were also assayed and the iCT values were found to be in the previously published range of 500-10,000 Pg/ml (10). The results from the patients in the study are summarized in Table 1. Interassay variation was approximately 20% and intraassay 10%, in agreement with Deftos (4). Serum iCT levels were markedly elevated in the four patients with acute pancreatitis. The levels were maximal initially and fell gradually over the ensuing course. Sera from two of the patients that demonstrated high levels of iCT were assayed at 738
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ABSTRACT. Caicitonin was measured in four patients with acute pancreatitis with hypocaicemia. A marked elevation of this hormone was noted in each case and persisted over several days. The peak level of caicitonin preceded the maximum fall in calcium. Among the various factors affecting calcium balance in pancreatitis, calcitonin probably plays an important role.
739
RAPID C O M M U N I C A T I O N S Table 1 Day: Case #1
1 3700 485 9.2 4.6 4.1
Case #2: iCT Amylase Lipase Ca PO Alb
5100 1570
iCT Amylase Lipase Ca PO Alb
2750 6345
Case #4: iCT Amylase Lipase Ca PO Alb
550 789
Case #3:
8.2
9.7
7.9
2650 2750 606 7.5 2.3 3J
TTOO 1000
6.4
7.5 2.2
4850 1346 8.1 8.8 2.8 2.9
4 5 6 500 355" 355