Chromogranin A in diagnosis of pheochromocytoma (comparative analysis)

Marina Yu. Yukina; Юкина Марина Юрьевна; Polina L. Karpova; Карпова Полина Львовна; Ekaterina A. Troshina; Трошина Екатерина Анатольевна; Nadezhda M. Platonova; Платонова Надежда Михайловна; Dmitry G. Beltsevich; Бельцевич Дмитрий Германович

doi:10.26442/00403660.2021.04.200678

Chromogranin A in diagnosis of pheochromocytoma (comparative analysis)

作者: Yukina M.Y.¹, Karpova P.L.¹, Troshina E.A.¹, Platonova N.M.¹, Beltsevich D.G.²
隶属关系:
1. Endocrinology Research Centre
2. Endocrinology Research Center
期: 卷 93, 编号 4 (2021)
页面: 389-396
栏目: Original articles
URL: https://journals.rcsi.science/0040-3660/article/view/34769
DOI: https://doi.org/10.26442/00403660.2021.04.200678
ID: 34769

如何引用文章

全文:

详细
全文:
作者简介
参考
补充文件
统计

详细

Aim. To study the prognostic value of determining Chromogranin A blood level in the diagnosis of PHEO.

Materials and methods. We conducted a comparative analytical study of 157 patients with suspected PHEO, statistical analysis of 24-hour urinary metanephrine and normetanephrine excretion test was performed, as well as a blood test for CrA, in groups that included patients without PHEO, with primary tumor or its recurrence, confirmed according to MSCT and/or scintigraphy with MIBG and/or the clonidine suppression test.

Results. The parameters of efficiency of these methods were calculated by groups and it was noted that the lowest sensitivity of the CrA determination method was observed in the group with recurrence of PHEO (43.8%), their exclusion from the entire sample didn’t change specificity of the method and it remained at a high level (85.45%), though sensitivity significantly increased up to 87.1%. Sensitivity of determining 24-hour urinary metanephrine excretion also increased significantly up to 96.8%, with 98.2% of specificity. The correlation between diameter of the tumor and its secretory activity was identified: small – with CrA level (rho 0.491) and strong – with total level of methylated catecholamines (rho 0.765). False positive results were more often observed in patients present with other neuroendocrine tumors (37.5%), as well as those taking proton-pump inhibitors (43.75%). The sensitivity and specificity of CrA determining method in the group of patients with methanephrins elevated within “gray zone” appeared to be 50 and 86.1%, respectively.

Conclusion. A blood test for CrA can be recommended as a confirmatory test for diagnosing PHEO in cases of questionable methylated catecholamines indicators or in cases of suspected relapse of PHEO. The use of the test as a first-line method is only possible if there is no possibility to study methylated catecholamines. When interpreting CrA level, it is necessary to take into account the conditions that may cause false-positive results.

关键词

pheochromocytoma, chromogranin A, methanephrine, normetanephrine, catecholamines

全文:

MD, PhD, Сhief Researcher of Department of Surgery

俄罗斯联邦, Moscow

参考

Chen H, Sippel RS, O’Dorisio MS, et al. The north american neuroendocrine tumor society consensus guideline for the diagnosis and management of neuroendocrine tumors: Pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas. 2010;39(6):775-83. doi: 10.1097/MPA.0b013e3181ebb4f0
Omura M, Saito J, Yamaguchi K, et al. Prospective Study on the Prevalence of Secondary Hypertension among Hypertensive Patients Visiting a General Outpatient Clinic in Japan. Hypertens Res Vol. 2003;27(3):193-202. doi: 10.1291/hypres.27.193
Neumann HPH, Young WFJr, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med. 2019;381(6):552-65. doi: 10.1056/NEJMra1806651
Mannelli M, Lenders JWM, Pacak K, et al. Subclinical phaeochromocytoma. Best Pract Res Clin Endocrinol Metab. 2012;26(4):507-15. doi: 10.1016/j.beem.2011.10.008
Gimm O, Koch CA, Januszewicz A, et al. The genetic basis of pheochromocytoma. Front Horm Res. 2004;31:45-60. doi: 10.1159/000074657
Zuber S, Wesley R, Prodanov T, et al. Clinical utility of chromogranin A in SDHx- related paragangliomas. Eur J Clin Invest. 2014;44(4):365-71. doi: 10.1111/eci.12245
Lenders JWM, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. doi: 10.1210/jc.2014-1498
Hsiao RJ, Parmer RJ, Takiyyuddin MA, O’Connor DT. Chromogranin A storage and secretion: sensitivity and specificity for the diagnosis of pheochromocytoma. Medicine (Baltimore). 1991;70(1):33-45. doi: 10.1097/00005792-199101000-00003
Bílek R, Ík LŠŘ, Ciprová V, et al. Chromogranin A, a member of neuroendocrine secretory proteins as a selective marker for laboratory diagnosis of pheochromocytoma. Physiol Res. 2008;57:171-9.
Bílek R, Zelinka T, Vlček P, et al. Radioimmunoassay of Chromogranin A and Free Metanephrines in Diagnosis of Pheochromocytoma. Physiol Res. 2017;66:397-408. doi: 10.33549/physiolres.933719
Bílek R, Zelinka T, Vlček P, et al. Deconjugated Urinary Metanephrine, Normetanephrine and 3-Methoxytyramine in Laboratory Diagnosis of Pheochromocytoma and Paraganglioma. Physiol Res. 2015;64:313-22. doi: 10.33549/physiolres.933109. PMID: 26680494
Unger N, Hinrichs J, Deutschbein T, et al. Plasma and Urinary Metanephrines Determined by an Enzyme Immunoassay, but not Serum Chromogranin A for the Diagnosis of Pheochromocytoma in Patients with Adrenal Mass. Exp Clin Endocrinol Diabetes. 2012;120(8):494-500. doi: 10.1055/s-0032-1309007
Al-risi ES, Al-essry FS. Chromogranin A as a Biochemical Marker for Neuroendocrine Tumors: A Single Center Experience at Royal Hospital, Oman. Oman Med J. 2017;32(5):365-70. doi: 10.5001/omj.2017.71
Yang X, Yang Y, Li Z, et al. Diagnostic value of circulating chromogranin a for neuroendocrine tumors: A systematic review and meta-analysis. PLoS One. 2015;10(4):1-14. doi: 10.1371/journal.pone.0124884
Kidd M, Bodei L, Modlin IM. Chromogranin A: any relevance in neuroendocrine tumors? Curr Opin Endocrinol Diabetes Obes. 2016. 2016;23(1):28-37. doi: 10.1097/MED.0000000000000215
Cimitan M, Buonadonna A, Cannizzaro R, et al. Somatostatin receptor scintigraphy versus chromogranin A assay in the management of patients with neuroendocrine tumors of different types: Clinical role. Ann Oncol. 2003;14(7):1135-41. doi: 10.1093/annonc/mdg279
Zawadzka-Leska SK, Radziszewski M, Malec K, Stadnik AUA. Predictive value of chromogranin a in a diagnosis towards Pheochromocytoma in adrenal incidentaloma. Endocr Care. 2016;12(4):437-42. doi: 10.4183/aeb.2016.437
Glinicki P, Jeske W, Bednarek-Papierska L, et al. Chromogranin A (CgA) in adrenal tumours. Endokrynol Pol. 2013;64(5):358-62. doi: 10.5603/ep.2013.0018
Giovanella L, Ceriani L, Balerna M, et al. Diagnostic value of serum chromogranin-A combined with MIBG scintigraphy in patients with adrenal incidentalomas. Q J Nucl Med Mol Imaging. 2008;52(1):84-8.
De Jong WHA, Eisenhofer G, Post WJ, et al. Dietary influences on plasma and urinary metanephrines: Implications for diagnosis of catecholamine-producing tumors. J Clin Endocrinol Metab. 2009;94(8):2841-9. doi: 10.1210/jc.2009-0303
Юкина М.Ю., Трошина Е.А,. Бельцевич Д.Г., и др. Феохромоцитома/параганглиома: клинико-генетические аспекты. Проблемы эндокринологии. 2013;3:19-26 [Yukina MY, Troshina EA, Beltsevich DG, et al. Pheochromocytoma/paraganglioma: clinical and genetic aspects. Problemy endokrinologii. 2013;3:19-2 (In Russ.)]. doi: 10.14341/probl201359319-26
Ardill JES, O’Dorisio TM. Circulating biomarkers in neuroendocrine tumors of the enteropancreatic tract: application to diagnosis, monitoring disease, and as prognostic indicators. Endocrinol Metab Clin North Am. 2010;39(4):777-90. doi: 10.1016/j.ecl.2010.09.001
Martucci VL, Pacak K. Pheochromocytoma and Paraganglioma: Diagnosis, Genetics, Management, and Treatment. Curr Probl Cancer. 2014;38(1):7-41. doi: 10.1038/jid.2014.371
Herman DS, Lam L, Taylor M, et al. Catecholamine metabolomic and secretory phenotypes in phaeochromocytoma. Endocr Relat Cancer. 2011;18(1):97-111. doi: 10.1038/jid.2014.371
Pregun I, Herszényi L, Juhász M, et al. Effect of proton-pump inhibitor therapy on serum chromogranin A level. Digestion. 2011;84(1):22-8. doi: 10.1159/000321535

补充文件

附件文件

动作

1. JATS XML

下载

2. Fig. 1. The effectiveness of methods for determining ChrA in the analysis of blood and MCA in the analysis of daily urine in the 1st group

下载 (87KB)

索引源数据

3. Fig. 2. The effectiveness of the method for determining ChrA in groups 1 and 5

下载 (89KB)

索引源数据

4. Fig. 3. The effectiveness of the method for determining MCA in groups 1 and 5

下载 (88KB)

索引源数据

5. Fig. 4. The effectiveness of methods for determining ChrA in the analysis of blood and MCA in the analysis of daily urine in the 5th group

下载 (86KB)

索引源数据

6. Fig. 5. Correlation between tumor size and ChrA level in groups 2 and 3

下载 (111KB)

索引源数据

7. Fig. 6. Correlation between the ChrA level and the total MCA level in the 2nd and 3rd groups

下载 (105KB)

索引源数据

8. Fig. 7. The effectiveness of methods for determining ChrA in the analysis of blood and MCA in the analysis of daily urine in the 10th group

下载 (85KB)

索引源数据

用户名
密码
记住我

忘记您的密码?	注册

用户名
密码
记住我

忘记您的密码?	注册