Increased plasma calcitonin levels in systemic mast cell disease

M. W. Yocum, J. H. Butterfield, H. Gharib

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Aspirin therapy for patients with systemic mast cell disease (SMCD) decreases the production of prostaglandin D2, which is thought to be a major mediator of flushing. Paradoxically, in 5 to 10% of patients with SMCD, administration of aspirin causes massive mediator release and an anaphylactoid reaction. We attempted aspirin desensitization in a 34-year- old man with SMCD (confirmed by bone marrow biopsy) who was incapacitated by severe flushing episodes and hypotension. His baseline mediator levels of plasma calcitonin, urinary histamine, and urinary N-methyl-imidazoleacetic acid were abnormal. Pentagastrin stimulation increased the plasma level of calcitonin from 47 pg/mL to 130 pg/mL (normal, less than or equal to 110) at 5 minutes. Oral aspirin desensitization was begun; however, after a cumulative dose of 620 mg, an anaphylactoid reaction ensued in conjunction with hypotension, abdominal cramping, and flushing. Coincidentally, 1 hour after the episode, the plasma calcitonin level increased from 37 pg/mL to 540 pg/mL, and the serum tryptase level increased from 1 ng/mL to 3.9 ng/mL. Six hours after the episode, the urine level of histamine increased from 90 μg/g creatinine to 337 μg/g creatinine, and the urinary N-methylimidazoleacetic acid increased from 32 mg/24 h to 81 mg/24 h. Hence, the patient had increased basal levels of plasma calcitonin that increased substantially during aspirin desensitization and increased to above the upper limit of normal during pentagastrin stimulation. Human mast cells may be capable of producing calcitonin or causing secretion of calcitonin in response to skeletal changes.

Original languageEnglish (US)
Pages (from-to)987-990
Number of pages4
JournalMayo Clinic Proceedings
Volume69
Issue number10
StatePublished - 1994

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Systemic Mastocytosis
Calcitonin
Aspirin
Pentagastrin
Hypotension
Histamine
Creatinine
Prostaglandin D2
Tryptases
Mast Cells
Bone Marrow
Urine
Biopsy
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Yocum, M. W., Butterfield, J. H., & Gharib, H. (1994). Increased plasma calcitonin levels in systemic mast cell disease. Mayo Clinic Proceedings, 69(10), 987-990.

Increased plasma calcitonin levels in systemic mast cell disease. / Yocum, M. W.; Butterfield, J. H.; Gharib, H.

In: Mayo Clinic Proceedings, Vol. 69, No. 10, 1994, p. 987-990.

Research output: Contribution to journalArticle

Yocum, MW, Butterfield, JH & Gharib, H 1994, 'Increased plasma calcitonin levels in systemic mast cell disease', Mayo Clinic Proceedings, vol. 69, no. 10, pp. 987-990.
Yocum MW, Butterfield JH, Gharib H. Increased plasma calcitonin levels in systemic mast cell disease. Mayo Clinic Proceedings. 1994;69(10):987-990.
Yocum, M. W. ; Butterfield, J. H. ; Gharib, H. / Increased plasma calcitonin levels in systemic mast cell disease. In: Mayo Clinic Proceedings. 1994 ; Vol. 69, No. 10. pp. 987-990.
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