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Context Calcitonin (CT) measurement is pivotal in the management of medullary thyroid carcinoma (MTC), but several pitfalls can affect its reliability. Procalcitonin (ProCT) has been reported as a promising alternative MTC tumor marker. Objective This study aimed to determine the ProCT diagnostic accuracy in prediction and treatment monitoring of MTC. Methods Electronic databases were searched for observational studies published until May 2021 without language or time restrictions. Studies comparing ProCT and calcitonin accuracy were included. After removing duplicates and exclusion of not-eligible articles, relevant articles were screened independently by 2 reviewers. Eleven studies (4.5% of the identified studies) met the selection criteria. Two reviewers independently extracted data and assessed data quality and validity through QUADAS-2. Results A meta-analysis was performed on 11 sufficiently clinically and statistically homogeneous studies (n = 5817 patients, 335 MTC patients). Hierarchical summary receiver operating characteristics and bivariate methods were applied. Serum ProCT was found to be a highly accurate test for MTC diagnosis and monitoring. The pooled sensitivity, specificity, positive and negative likelihood ratios, area under the curve, and positive and negative predictive values for ProCT were 0.90 (95% CI: 0.71-0.97), 1.00 (95% CI: 0.85-1.00), 288 (95% CI: 5.6-14 929.3), 0.10 (95% CI: 0.03-0.33), 0.97 (95% CI: 0.95-0.98), 99%, and 2%, respectively. Conclusions The high accuracy, compounded with favorable analytical characteristics, give ProCT great potential to replace calcitonin as a new standard of care in the management of MTC.

A 50-year-old woman with papillary thyroid carcinoma (PTC) [pT3(m),pN1a], treated by surgery and radioiodine ablation (6.2 GBq) 22 years before, was referred to our center for restaging due to increased serum thyroglobulin levels (65 ng/mL) after a 5-year period in which she has been lost at follow-up. Neck ultrasonography (US), thoracic computed tomography (CT), and I-whole-body scan were negative for recurrences. Fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/CT showed 2 areas of increased uptake in the left trapezius and right subscapularis muscles without abnormal findings at coregistered CT. Therefore, the patient underwent a F-FDG-PET/magnetic resonance imaging (MRI), which showed increased uptake in 2 hyperdense lesions in the left trapezius (4.2 cm) and right subscapularis muscles (2.5 cm) (Figure 1). Based on these findings, the patient underwent a biopsy of the muscle lesions. Histopathological pattern was consistent with muscular metastases from PTC (Figure 2), and the patient was addressed to surgery. PTC is a slowly progressive cancer with a high 10-year survival rate (85–95%). Distant metastases are seen in 3–15% of PTC patients, mostly in the lungs, followed by the bone. Muscular metastases of PTC are very rare, but detecting them has a significant impact on the clinical management and prognosis of patients (1, 2). The usefulness of F-FDG-PET/CT for detecting PTC recurrences in patients with increased thyroglobulin levels and negative I-whole-body scan is well known (3). Conversely, only 1 article, limited to the study of the neck, reported the usefulness of F-FDG-PET/MRI in this setting (4). This emerging technique (5) has been useful in our case to detect unusual PTC metastases.

The aim of this study was to evaluate the influence of blood pressure (BP) control and familial predisposition to hypertension on longitudinal changes in insulin sensitivity in essential hypertension. We evaluated 6 groups of subjects twice (basal: before any treatment; 2nd: after at least 18 months): 42 hypertensives (H) with a family history of hypertension (F+) and 30 H without a family history of hypertension (F-) successfully treated with angiotensin-converting enzyme inhibitors and/or calcium channel blockers (2nd: 24-h BPor = 130/80 mm Hg); 22 untreated (UT) HF+ and 18 UTHF- (2nd: 24-h BP140 and/or 90 mm Hg); 18 normotensives F+ and 15 normotensives F-. The parameters evaluated were as follows: glucose, insulin, and C-peptide (Cp) response to an oral glucose load. Glucose was normal in all of the subjects, similar among the 6 groups, and unchanged at the 2nd evaluation. At the basal evaluation insulin and Cp were higher and the metabolic clearance rate (MCR) of glucose was lower in the three F+ groups compared with the corresponding F- groups. In the 2nd evaluation insulin and Cp were reduced and the MCR of glucose increased in THF-, whereas all metabolic parameters were unchanged in THF+; in both UT hypertensive groups insulin and Cp increased and the MCR of glucose decreased, more so in F+ than in F-; in normotensive groups metabolic parameters did not change. A familial predisposition to hypertension influences insulin sensitivity changes during successful antihypertensive therapy, with an improvement in insulin sensitivity in F- and no changes in F+. A persistently high BP has a negative influence on insulin sensitivity in F+ and F-; this influence is greater when high BP is associated with a familial predisposition to hypertension.