The role of chromogranin A in the management of patients with phaeochromocytoma

Grossrubatscher, Erika; Dalino, Paolo; Vignati, Federico; Gambacorta, Marcello; Pugliese, Raffaele; Boniardi, Marco; Rossetti, O.; Marocchi, Alessandro; Bertuzzi, Michaela; Loli, Paola

doi:10.1111/j.1365-2265.2006.02591.x

Cited by 67 publications

(49 citation statements)

References 24 publications

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“…Other potential mechanisms such as storage and secretion of catecholamines are still intact as secretory granules were observed in resected tumour tissue and tumours did show accumulation of the radiotracer MIBG, a catecholamine analogue that is taken up by and stored in secretory granules. Therefore, tumour screening in SDHB mutation carriers should not be limited to biochemical tests of catecholamine excess, but may include additional measurements including plasma chromogranin A, a nonspecific neuroendocrine secretory protein, and imaging studies (61,62,63,64).…”

Section: Sources Of False-negative Test Resultsmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Biochemical diagnosis of phaeochromocytoma and paraganglioma

Berkel

Lenders

Timmers

2014

European Journal of Endocrinology

142

112

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Adrenal phaechromocytomas and extra-adrenal sympathetic paragangliomas (PPGLs) are rare neuroendocrine tumours, characterised by production of the catecholamines: noradrenaline, adrenaline and dopamine. Tumoural secretion of catecholamines determines their clinical presentation which is highly variable among patients. Up to 10-15% of patients present entirely asymptomatic and in 5% of all adrenal incidentalomas a PPGL is found. Therefore, prompt diagnosis of PPGL remains a challenge for every clinician. Early consideration of the presence of a PPGL is of utmost importance, because missing the diagnosis can be devastating due to potential lethal cardiovascular complications of disease. First step in diagnosis is proper biochemical analysis to confirm or refute the presence of excess production of catecholamines or their metabolites. Biochemical testing is not only indicated in symptomatic patients but also in asymptomatic patients with adrenal incidentalomas or identified genetic predispositions. Measurements of metanephrines in plasma or urine offer the best diagnostic performance and are the tests of first choice. Paying attention to sampling conditions, patient preparation and use of interfering medications is important, as these factors can largely influence test results. When initial test results are inconclusive, additional tests can be performed, such as the clonidine suppression test. Test results can also be used for estimation of tumour size or prediction of tumour location and underlying genotype. Furthermore, tumoural production of 3-methoxytyramine is associated with presence of an underlying SDHB mutation and may be a biomarker of malignancy.

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Section: Sources Of False-negative Test Resultsmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Biochemical diagnosis of phaeochromocytoma and paraganglioma

Berkel

Lenders

Timmers

2014

European Journal of Endocrinology

142

112

View full text Add to dashboard Cite

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“…Pomocnym badaniem może być również oznaczenie stężenia chromograniny A (CgA) w osoczu lub surowicy (czułość > 85%, swoistość > 90%) [26][27][28]; przy interpretacji wyniku należy zwrócić uwagę na możliwe wyniki fałszy-wie dodatnie: leczenie inhibitorami pompy protonowej oraz blokerami receptorów histaminowych typu H 2 , współ-istnienie innych guzów neuroendokrynnych (szczególnie: rakowiaka, gastrinoma, glukagonoma), raka prostaty, w obecności wysokiego stężenia czynnika reumatoidalnego w klasie IgM, lub niektórych chorób zapalnych przewodu pokarmowego (gastritis atrophicans typu A).…”

Section: Badania W Kierunku Guza Chromochłonnegounclassified

“…Another valuable test may be assessing serum or plasma chromogranin A concentrations (sensitivity > 85%, specificity > 90%) [26][27][28], although there is the possibility of obtaining false positive results in the following cases: if the patient was treated with proton pump inhibitors or H 2 receptor blockers, has concomitant neuroendocrine tumours (such as carci- …”

Section: Tests For Pheochromocytomamentioning

confidence: 99%

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

Bednarczuk

Bolanowski

Sworczak

et al. 2016

Endokrynologia Polska

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Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations. Methods: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations. Imaging and hormonal assessment: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia. Treatment: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases. (Endokrynol Pol 2016; 67 (2): 234-258)

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“…The main causes of interference in the CgA assay are renal insufficiency (27), followed by proton pump inhibitors or corticosteroids (23,37). Renal insufficiency raises the CgA concentrations and those of metanephrines (44). The increase is correlated with the creatinine clearance rate.…”

Section: Controls (Nz71)mentioning

confidence: 99%

An analysis of the biochemical diagnosis of 66 pheochromocytomas

d’Herbomez¹,

Forzy

Bauters

et al. 2007

eur j endocrinol

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Objectives: The aims of this study were to determine the performance of each variable, to define the optimal diagnostic thresholds and to determine the relative value of assaying chromogranin A (CgA). Design: Prospective study. Methods: Two groups of patients were studied: a control group of 71 patients and a group of 63 patients with a histologically-proven pheochromocytoma (52 pheochromocytomas and 14 paragangliomas). Fourteen of the patients had a family history of the disease. Eleven variables were assayed in each patient, i.e. the plasma and urinary concentrations of amines and their derivatives, and the CgA serum concentration.Results: The study of the control group showed that all the serum assays gave false positive results (from 6 to 23%), as did four of the six urinary assays (from 2.9 to 12.3%). The areas under the receiver operating characteristic curves varied from 0.689 to 0.992. The variables relating to the epinephrine pathway were significantly less expressed in the hereditary diseases than in the sporadic cases. The diagnostic thresholds of the three most efficient variables have been raised. Conclusions: Plasma determinations of metanephrines are now an easy and convenient tool for the diagnosis of pheochromocytoma. However, in our study the best specificity was obtained with the urinary tests rather than with the plasma assays while the highest sensitivities were for the normetanephrine assays. The assay of CgA was highly efficient in diagnosing pheochromocytomas in the absence of renal insufficiency. By combining it with fractionated metanephrine assays, the sensitivities of the latter were increased.European Journal of Endocrinology 156 569-575

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The role of chromogranin A in the management of patients with phaeochromocytoma

Abstract: Our results indicate that CgA is a good marker of phaeochromocytoma; measurement of CgA could have a role in the follow-up of patients operated on for phaeochromocytoma.

Cited by 67 publications

References 24 publications

DIAGNOSIS OF ENDOCRINE DISEASE: Biochemical diagnosis of phaeochromocytoma and paraganglioma

DIAGNOSIS OF ENDOCRINE DISEASE: Biochemical diagnosis of phaeochromocytoma and paraganglioma

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

An analysis of the biochemical diagnosis of 66 pheochromocytomas

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