{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:23:18Z","timestamp":1792815798106,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>An increased calcitonin serum level is suggestive of a medullary thyroid cancer (MTC), but is not pathognomonic. The possibility of false positives or other calcitonin-secreting neuroendocrine neoplasms (NENs) should be considered. Serum calcitonin levels are generally assessed by immunoradiometric and chemiluminescent assays with high sensitivity and specificity; however, slightly moderately elevated levels could be attributable to various confounding factors. Calcitonin values &gt;100 pg\/mL are strongly suspicious of malignancy, whereas in patients with moderately elevated values (10\u2013100 pg\/mL) a stimulation test may be applied to improve diagnostic accuracy. Although the standard protocol and the best gender-specific cut-offs for calcium-stimulated calcitonin are still controversial, the fold of the calcitonin increase after stimulation seems to be more reliable. Patients with MTC show stimulated calcitonin values at least three to four times higher than the basal values, whereas calcitonin-secreting NENs can be distinguished from a C-cell disease by the absence of or &lt;two-fold response to stimulation. The measurement of calcitonin in fine-needle aspirate washout (FNA-CT) and calcitonin immunocytochemical staining from thyroid nodules are ancillary methods that may significantly improve MTC diagnosis. The present review examines the gray areas in the interpretation of calcitonin measurement in order to provide a tool to clarify the origin of calcitonin secretion and differentiate the behavior of the two-faced Janus of neuroendocrinology: intra-thyroid (MTC) and extra-th9yroid NENs.<\/jats:p>","DOI":"10.1530\/eje-20-0506","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T16:33:18Z","timestamp":1601483598000},"page":"R197-R215","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":32,"title":["ENDOCRINE TUMOURS: Calcitonin in thyroid and extra-thyroid neuroendocrine neoplasms: the two-faced Janus"],"prefix":"10.1093","volume":"183","author":[{"given":"Elisa","family":"Giannetta","sequence":"first","affiliation":[{"name":"1Department of Experimental Medicine \u2018Sapienza\u2019 University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Guarnotta","sequence":"additional","affiliation":[{"name":"2Dept PROMISE, UOC Malattie Endocrine, del Ricambio e della Nutrizione, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Altieri","sequence":"additional","affiliation":[{"name":"3Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concetta","family":"Sciammarella","sequence":"additional","affiliation":[{"name":"4Department of Diagnostic and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elia","family":"Guadagno","sequence":"additional","affiliation":[{"name":"5Department of Advanced Biomedical Sciences, Pathology Section University \u2018Federico II\u2019, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasqualino","family":"Malandrino","sequence":"additional","affiliation":[{"name":"6Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Puliani","sequence":"additional","affiliation":[{"name":"1Department of Experimental Medicine \u2018Sapienza\u2019 University of Rome, Rome, Italy"},{"name":"7Oncological Endocrinology Unit, Regina Elena National Cancer Institute, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Feola","sequence":"additional","affiliation":[{"name":"1Department of Experimental Medicine \u2018Sapienza\u2019 University of Rome, Rome, Italy"},{"name":"8Neuroendocrinology Unit, Neuromed Institute, IRCCS, Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M","family":"Isidori","sequence":"additional","affiliation":[{"name":"1Department of Experimental Medicine \u2018Sapienza\u2019 University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria Anita Livia","family":"Colao","sequence":"additional","affiliation":[{"name":"1Department of Experimental Medicine \u2018Sapienza\u2019 University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antongiulio","family":"Faggiano","sequence":"additional","affiliation":[{"name":"1Department of Experimental Medicine \u2018Sapienza\u2019 University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/183\/6\/EJE-20-0506.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/downloadpdf\/journals\/eje\/183\/6\/EJE-20-0506.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T16:15:08Z","timestamp":1676391308000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/183\/6\/R197\/6653855"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":0,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.1530\/eje-20-0506","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}