n.
A peptide hormone, produced by the thyroid gland in humans, that lowers plasma calcium and phosphate levels without augmenting calcium accretion. Also called thyrocalcitonin.
calcitonin
Dictionary:
cal·ci·to·nin (kăl'sĭ-tō'nĭn)  |
| 5min Related Video: calcitonin |
| Oncology Encyclopedia: Calcitonin |
Key Terms: Paget's disease.
Definition
Calcitonin is a hormone involved in regulating calcium metabolism. The hormone calcitonin is produced by the thyroid gland. A synthetic human product, sold as Calcimar or Miacalcin, is available in the United States. A third brand called Fortical applied for U.S. Food and Drug Administration (FDA) approval in 2003 for marketing in the United States.
Purpose
Calcitonin is often ordered for cancer patients experiencing bone pain due to metastasis. Calcitonin is also used to treat Paget's disease, post-menopausal osteoporosis, and increased levels of calcium in the blood.
Description
Calcitonin reduces breakdown of bone. It causes less bone tissue to be reabsorbed. It slows the rate of bone destruction and decreases the amount of calcium released into the blood. Most calcitonin ordered for patients is derived from salmon. Calcitonin is not effective when given orally, and is available for injection or in a nasal spray.
Recommended Dosage
The usual dose for patients receiving calcitonin-salmon for bone metastases is 200 IU given through the vein twice daily. It is important to take this drug exactly as ordered. If a dose is missed and is noticed within two hours, the drug should be taken. If it is not noted until later, the patient should skip the dose and return to the regular schedule. Patients should not take additional or double doses. When using calcitonin to lower calcium levels, therapy is limited to approximately five days. Extended use of calcitonin results in a loss of calcium-lowering effect.
Precautions
Calcitonin-salmon solution should be stored in the refrigerator, not frozen. Patients should allow a new bottle of nasal spray to warm to room temperature. It may be kept at room temperature for two to four weeks. The nasal spray pump should be primed before using. Patients should push the plunger until a mist is observed, usually within several pushes. Before using, the patient should blow his or her nose. The patient should alternate nostrils with each dose. The head should be kept upright. The pump should be pressed toward the bottle one time. The patient should not inhale when spraying. The patient should then inhale through the nose and exhale through the mouth. The nosepiece should be wiped clean after each use. Patients giving themselves an injection should check that the contents are clear. Patients should not inject medication that is colored or grainy.
Calcitonin should be used cautiously when breast feeding, as it may decrease the amount of available milk. Its use during pregnancy has not been adequately studied. However, animal studies indicated a risk for low birth weight offspring.
Side Effects
Calcitonin is a protein. It may cause a severe allergic reaction. The doctor should be notified if a rash or hives develop. Patients should have supplies on hand to manage an allergic reaction. Skin testing may be done prior to treatment. Allergic reactions are rarer in the human product than in the salmon product.
Diarrhea, red skin, poor appetite, nausea, vomiting, stomach pain, and back and joint pain are common side effects. Other side effects include increased or decreased appetite, gas, constipation, or an unusual taste in the mouth. Nausea is usually mild and temporary. Giving calcitonin at bedtime may decrease nausea and vomiting. Patients may experience dizziness, difficulty sleeping, anxiety, headache, agitation, palpitations, or other heart problems. Redness, swelling and soreness may occur at the injection site. Patients using the nasal spray may develop crusting or patches in the nose, as well as nasal dryness, redness, swelling or irritation. Less often, those using the nasal spray may experience difficulty with urination, breathing problems, loss of smell, or cold symptoms. Some patients injecting the drug may develop frequent urination, chills, dizziness, headache, chest pressure, a congested nose, tingling or discomfort in the hands and feet, difficulty breathing or weakness. Patients should notify the doctor if side effects occur. Side effects may subside as the patient's body becomes accustomed to the drug. Patients should receive regular medical checks and lab work to assess for adverse reactions and changes in urine content.
Interactions
At present, there are no known interactions with other drugs.
Resources
Periodicals
Boersig, Charles."Nasal Calcitonin in Greece." Med Ad News November 2003: 14.
—Debra Wood, R.N.; Teresa G. Odle
| Dental Dictionary: calcitonin |
n
trade names: Calcitonin, Calcimar, Miacalcin; drug class: synthetic polypeptide calcitonins; action: inhibits bone resorption, reduces osteoclast function, reduces serum calcium levels in hypercalcemia; uses: Paget’s disease, postmenopausal osteoporosis, hypercalcemia.
| Drug Info: Calcitonin |
Brand names: Miacalcin®
- Español:
- Inyección de calcitonina
Calcitonin injection
What is calcitonin injection?
CALCITONIN (Miacalcin®) controls the amount of calcium in your body and helps maintain proper bone density. Calcitonin is used to treat diseases of the bone such as Paget's disease and osteoporosis. Calcitonin is used to treat excess amounts of calcium in the blood. Generic calcitonin injection is available.What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:• low level of blood calcium
• an unusual or allergic reaction to calcitonin, fish, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding
How should I use this medicine?
Calcitonin is for injection into a muscle or under the skin. If you have been instructed to give yourself calcitonin injections, make sure that you understand how to prepare and inject the dose. Use exactly as directed. Do not exceed the prescribed dose, and do not use more or less often than prescribed.Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.
What if I miss a dose?
If you use two doses per day, give the missed dose only if you remember within 2 hours. Otherwise, skip the dose and resume your regular schedule with the next dose. Do not use double doses.If you use one dose per day, give the missed dose as soon as you remember on the day the dose was due. If you do not remember until the next day, skip the dose and resume your regular schedule with the next dose. Do not use double doses.
If you use one dose every other day, give the missed dose as soon as you remember on the day the dose was due. If you do not remember until the next day, use the dose and skip a day to resume an every-other-day schedule. Do not use double doses.
If you use three doses per week (Monday, Wednesday, Friday), give the missed dose as soon as you remember on the day the dose was due. If you do not remember until the next day, give the missed dose and give the rest of the doses a day later than normal. Do not use double doses or use doses two days in a row. Return to your regular schedule the following week.
What drug(s) may interact with calcitonin?
• lithiumTell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.
What should I watch for while taking calcitonin?
Visit your prescriber or health care professional for regular checks on your progress. Calcitonin can make your blood calcium level dangerously low. You will need regular blood tests while using calcitonin. Ask your prescriber or health care professional about calcium in your diet.You may also need to take supplements of calcium and vitamin D while you are receiving calcitonin, unless you are being treated for high calcium levels. Discuss whether calcium and vitamin D supplements are right for you with your prescriber or health care provider.
Store needles and syringes out of the reach of children. Make sure you receive a puncture-resistant container to dispose of the needles and syringes once you have finished with them. Do not reuse these items. Return the container to your prescriber or health care professional for proper disposal.
What side effects may I notice from receiving calcitonin?
Side effects that you should report to your prescriber or health care professional as soon as possible:• chest pain, fast or irregular heartbeat (palpitations)
• difficulty breathing, wheezing
• dizziness
• fever, chills
• rash or itching (hives)
• swelling of the tongue, difficulty swallowing
• tingling in the hands or feet
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• diarrhea
• flushing (reddening of the face, ears, or hands)
• headache
• heartburn
• loss of appetite
• nausea, vomiting
• pain, redness, irritation or swelling at the injection site
• stomach pain
Where can I keep my medicine?
Keep out of the reach of children.Store in a refrigerator between 2—8 degrees C (36—46 degrees F); do not freeze. Throw away any unused medicine after the expiration date.
Last updated: 7/1/2002
Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.
| Sports Science and Medicine: calcitonin |
A polypeptide hormone secreted by the thyroid gland which is a major regulator of calcium ion concentration in the blood of children. It inhibits bone degradation and stimulates the uptake of calcium and phosphate by bone.
| Veterinary Dictionary: calcitonin |
A polypeptide hormone secreted by the parafollicular or C cells of the thyroid gland, which is involved in plasma calcium homeostasis. It acts to decrease the rate of bone resorption. Called also thyrocalcitonin.
- c. gene-related peptides — potent vasodilators widely distributed in periadventitial nerves of blood vessels, sinoatrial and atrioventricular nodes, sensory neurons and the central nervous system generally.
- c.-secreting cells — parafollicular cells of the thyroid gland.
| Wikipedia: Calcitonin |
| edit |
Calcitonin is a 32-amino acid linear polypeptide hormone that is produced in humans primarily by the parafollicular cells (also known as C-cells) of the thyroid, and in many other animals in the ultimobranchial body.[2] It acts to reduce blood calcium (Ca2+), opposing the effects of parathyroid hormone (PTH).[3] It has been found in fish, reptiles, birds, and mammals. Its importance in humans has not been as well established as its importance in other animals, as its function is usually not significant in the regulation of normal calcium homeostasis.[4]
Contents |
Biosynthesis
Calcitonin is formed by the proteolytic cleavage of a larger prepropeptide, which is the product of the CALC1 gene (CALCA). The CALC1 gene belongs to a superfamily of related protein hormone precursors including islet amyloid precursor protein, calcitonin gene-related peptide, and the precursor of adrenomedullin.
Physiology
The hormone participates in calcium (Ca2+) and phosphorus metabolism. In many ways, calcitonin counteracts parathyroid hormone (PTH).
To be specific, calcitonin affects blood Ca2+ levels in three ways:
-
- Inhibits Ca2+ absorption by the intestines[5]
- Inhibits osteoclast activity in bones[6]
- Inhibits phosphate reabsorption by the kidney tubules[7]
- Increases absolute Ca2+ and Mg+ reabsorption by the kidney tubules, calcitonin is a renal Ca-conserving hormone.[7]
Secretion of calcitonin is stimulated by:
-
- an increase in serum [Ca2+][8]
- gastrin and pentagastrin.[9]
Actions
Its actions, in a broad sense, are:
- Bone mineral metabolism:
- - Protect against Ca2+ loss from skeleton during periods of Ca2+ stress such as pregnancy and lactation
- Serum calcium level regulation
- - Prevent postprandial hypercalcemia resulting from absorption of Ca2+ from foods during a meal
- - Vitamin D regulation
- A satiety hormone:
- - Inhibit food intake in rats and monkeys
- - May have CNS action involving the regulation of feeding and appetite
Receptor
The calcitonin receptor, found primarily on osteoclasts[10], is a G protein-coupled receptor, which is coupled by Gs to adenylyl cyclase and thereby to the generation of cAMP in target cells. It also affect the ovaries in women and the testes in men.
Discovery
Calcitonin was purified in 1962 by Copp and Cheney.[11] While it was initially considered a secretion of the parathyroid glands, it was later identified as the secretion of the C-cells of the thyroid gland.[12]
Pharmacology
Salmon calcitonin is used for the treatment of:
- Postmenopausal osteoporosis
- Hypercalcaemia
- Paget's disease
- Bone metastases
- Phantom limb pain[13]
The following information is from the UK Electronic Medicines Compendium[14]
General characteristics of the active substance
Salmon calcitonin is rapidly absorbed and eliminated. Peak plasma concentrations are attained within the first hour of administration.
Animal studies have shown that calcitonin is primarily metabolised via proteolysis in the kidney following parenteral administration. The metabolites lack the specific biological activity of calcitonin. Bioavailability following subcutaneous and intramuscular injection in humans is high and similar for the two routes of administration (71% and 66%, respectively).
Calcitonin has short absorption and elimination half-lives of 10-15 minutes and 50-80 minutes, respectively. Salmon calcitonin is primarily and almost exclusively degraded in the kidneys, forming pharmacologically-inactive fragments of the molecule. Therefore, the metabolic clearance is much lower in patients with end-stage renal failure than in healthy subjects. However, the clinical relevance of this finding is not known. Plasma protein binding is 30% to 40%.
Characteristics in patients
There is a relationship between the subcutaneous dose of calcitonin and peak plasma concentrations. Following parenteral administration of 100 IU calcitonin, peak plasma concentration lies between about 200 and 400 pg/ml. Higher blood levels may be associated with increased incidence of nausea and vomiting.
Preclinical safety data
Conventional long-term toxicity, reproduction, mutagenicity, and carcinogenicity studies have been performed in laboratory animals. Salmon calcitonin is devoid of embryotoxic, teratogenic, and mutagenic potential.
An increased incidence of pituitary adenomas has been reported in rats given synthetic salmon calcitonin for 1 year. This is considered a species-specific effect and of no clinical relevance. Salmon calcitonin does not cross the placental barrier.
In lactating animals given calcitonin, suppression of milk production has been observed. Calcitonin is secreted into the milk.
Pharmaceutical manufacture
Calcitonin was extracted from the Ultimobranchial glands (thyroid-like glands) of fish, particularly salmon. Salmon calcitonin resembles human calcitonin, but is more active. At present, it is produced either by recombinant DNA technology or by chemical peptide synthesis. The pharmacological properties of the synthetic and recombinant peptides have been demonstrated to be qualitatively and quantitatively equivalent.[14]
Uses of calcitonin
Treatments
Calcitonin can be used therapeutically for the treatment of hypercalcemia or osteoporosis.
Oral calcitonin may have a chondroprotective role in osteoarthritis (OA), according to data in rats presented in December, 2005, at the 10th World Congress of the Osteoarthritis Research Society International (OARSI) in Boston, Massachusetts. Although calcitonin is a known antiresorptive agent, its disease-modifying effects on chondrocytes and cartilage metabolisms have not been well established until now.
This new study, however, may help to explain how calcitonin affects osteoarthritis. “Calcitonin acts both directly on osteoclasts, resulting in inhibition of bone resorption and following attenuation of subchondral bone turnover, and directly on chondrocytes, attenuating cartilage degradation and stimulating cartilage formation,” says researcher Morten Karsdal, MSC, PhD, of the department of pharmacology at Nordic Bioscience in Herlev, Denmark. “Therefore, calcitonin may be a future efficacious drug for OA.”[15]
Subcutaneous injections of calcitonin in patients suffering from mania resulted in significant decreases in irritability, euphoria and hyperactivity and hence calcitonin holds promise for treating bipolar disorder.[16] However no further work on this potential application of calcitonin has been reported.
Diagnostics
It may be used diagnostically as a tumor marker for a form of thyroid cancer (medullary thyroid adenocarcinoma), in which high calcitonin levels may be present and elevated levels after surgery may indicate recurrence. It may even be used on biopsy samples from suspicious lesions (e.g., swollen lymph nodes) to establish whether they are metastasis of the original cancer.
Structure
Calcitonin is a polypeptide hormone of 32 amino acids, with a molecular weight of 3454.93 daltons. Its structure comprises a single alpha helix.[1] Alternative splicing of the gene coding for calcitonin produces a distantly related peptide of 37 amino acids, called calcitonin gene-related peptide (CGRP), beta type.[17]
The following are the amino acid sequences of salmon and human calcitonin:[18]
- salmon: Cys-Ser-Asn-Leu-Ser-Thr-Cys-Val-Leu-Gly-Lys-Leu-Ser-Gln-Glu-Leu-His-Lys-Leu-Gln-Thr-Tyr-Pro-Arg-Thr-Asn-Thr-Gly-Ser-Gly-Thr-Pro
- human: Cys-Gly-Asn-Leu-Ser-Thr-Cys-Met-Leu-Gly-Thr-Tyr-Thr-Gln-Asp-Phe-Asn-Lys-Phe-His-Thr-Phe-Pro-Gln-Thr-Ala-Ile-Gly-Val-Gly-Ala-Pro
Compared to salmon calcitonin, human calcitonin differs at 16 residues.
See also
References
- ^ a b PDB 2glhAndreotti G, Méndez BL, Amodeo P, Morelli MA, Nakamuta H, Motta A (August 2006). "Structural determinants of salmon calcitonin bioactivity: the role of the Leu-based amphipathic alpha-helix". J. Biol. Chem. 281 (34): 24193–203. doi:. PMID 16766525.
- ^ Costoff A. "Sect. 5, Ch. 6: Anatomy, Structure, and Synthesis of Calcitonin (CT)". Endocrinology: hormonal control of calcium and phosphate. Medical College of Georgia. http://www.lib.mcg.edu/edu/eshuphysio/program/section5/5ch6/s5ch6_21.htm. Retrieved 2008-08-07.
- ^ Boron WF, Boulpaep EL (2004). "Endocrine system chapter". Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. ISBN 1-4160-2328-3.
- ^ Costoff A. "Sect. 5, Ch. 6: Biological Actions of CT". Medical College of Georgia. http://www.lib.mcg.edu/edu/eshuphysio/program/section5/5ch6/s5ch6_23.htm. Retrieved 2008-08-07.
- ^ Costoff A. "Sect. 5, Ch. 6: Effects of CT on the Small Intestine". Medical College of Georgia. http://www.lib.mcg.edu/edu/eshuphysio/program/section5/5ch6/s5ch6_26.htm. Retrieved 2008-08-07.
- ^ Costoff A. "Sect. 5, Ch. 6: Effects of CT on Bone". Medical College of Georgia. http://www.lib.mcg.edu/edu/eshuphysio/program/section5/5ch6/s5ch6_24.htm. Retrieved 2008-08-07.
- ^ a b Carney SL (1997). "Calcitonin and human renal calcium and electrolyte transport". Miner Electrolyte Metab 23 (1): 43–7. PMID 9058369.
- ^ Costanzo, Linda S. (2007). BRS Physiology. Lippincott, Williams, & Wilkins. pp. 263. ISBN 978-0781773119. http://www.amazon.com/Physiology-Board-Review-Linda-Costanzo/dp/0781773113/.
- ^ Erdogan MF, Gursoy A, Kulaksizoglu M (October 2006). "Long-term effects of elevated gastrin levels on calcitonin secretion". J Endocrinol Invest. 29 (9): 771–775. PMID 17114906. http://www.kurtis.it/abs/index.cfm?id_articolo_numero=3037.
- ^ Nicholson GC, Moseley JM, Sexton PM, et al (1986). "Abundant calcitonin receptors in isolated rat osteoclasts. Biochemical and autoradiographic characterization". J Clin Invest 78 (2): 355-60. PMID 3016026.
- ^ Copp DH, Cheney B (January 1962). "Calcitonin-a hormone from the parathyroid which lowers the calcium-level of the blood". Nature 193: 381–2. doi:. PMID 13881213.
- ^ Hirsch PF, Gauthier GF, Munson PL (august 1963). "Thyroid hypocalcemic principle and recurrent laryngeal nerve injury as factors affecting the response to parathyroidectomy in rats". Endocrinology 73: 244–252. PMID 14076205.
- ^ Wall GC, Heyneman CA (April 1999). "Calcitonin in phantom limb pain". Ann Pharmacother 33 (4): 499–501. doi:. PMID 10332543.
- ^ a b "Electronic Medicines Compendium". http://emc.medicines.org.uk/. Retrieved 2008-08-07.
- ^ Kleinman DM (2006-01-04). "Oral Calcitonin May Delay Onset of Joint Disease and Relieve Pain of OA". Musculoskeletal Report. Musculoskeletal Report, LLC. http://www.mskreport.com/articles.cfm?ArticleID=515. Retrieved 2008-08-07.
- ^ Vik A, Yatham LN (March 1998). "Calcitonin and bipolar disorder: a hypothesis revisited". J Psychiatry Neurosci 23 (2): 109–17. PMID 9549251.
- ^ "calcitonin domain annotation". SMART (a Simple Modular Architecture Research Tool). embl-heidelberg.de. http://smart.embl-heidelberg.de/smart/do_annotation.pl?BLAST=DUMMY&DOMAIN=SM00113. Retrieved 2009-02-22.
- ^ http://www.newworldencyclopedia.org/entry/Calcitonin
Further reading
- MacIntyre I, Alevizaki M, Bevis PJ, Zaidi M (1987). "Calcitonin and the peptides from the calcitonin gene". Clin. Orthop. Relat. Res. &na; (217): 45–55. doi:. PMID 3549095.
- Di Angelantonio S, Giniatullin R, Costa V, et al. (2004). "Modulation of neuronal nicotinic receptor function by the neuropeptides CGRP and substance P on autonomic nerve cells". Br. J. Pharmacol. 139 (6): 1061–73. doi:. PMID 12871824.
- Findlay DM, Sexton PM (2005). "Calcitonin". Growth Factors 22 (4): 217–24. doi:. PMID 15621724.
- Sponholz C, Sakr Y, Reinhart K, Brunkhorst F (2007). "Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature". Critical care (London, England) 10 (5): R145. doi:. PMID 17038199.
- Schneider HG, Lam QT (2007). "Procalcitonin for the clinical laboratory: a review". Pathology 39 (4): 383–90. doi:. PMID 17676478.
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 | Why is calcitonin important? (anatomy) |
| What is the relationship between parathyroid hormone (PTH) and calcitonin? (anatomy) |
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Mentioned in
- Why is calcitonin important? (anatomy)
- What is the relationship between parathyroid hormone (PTH) and calcitonin? (anatomy)
- C cells (histology)
- ultimobranchial body (embryology)
