Secretin and calcium provocative tests in the Zollinger-Ellison syndrome. A prospective study.
OBJECTIVE
To evaluate criteria of positivity for and usefulness of both the secretin and calcium gastrin-provocative tests in patients with the Zollinger-Ellison syndrome.


METHODS
Prospective trial in consecutive patients.


METHODS
Referrals to a clinical research center.


METHODS
Consecutive sample of 80 patients with the Zollinger-Ellison syndrome.


METHODS
Kabi-secretin (2 U/kg body weight) given by intravenous bolus and calcium gluconate (10%) (54 mg/kg.h [5 mg/kg.h of calcium]) given by continuous intravenous infusion for 3 hours. Serum gastrin measured at -15, and -1 minutes before, and 2, 5, 10, 15, 20, and 30 minutes after secretin, or every 30 minutes for 3 hours during the calcium infusion. Serum calcium and serum gastrin were measured simultaneously during the calcium infusion.


RESULTS
There was no significant difference in the responses of patients with different extents or locations of the tumor, presence or absence of multiple endocrine neoplasia, type-I, or with fasting gastrin less than or greater than 1000 pg/mL. In patients with fasting gastrin of less than 1000 pg/mL, the sensitivity of the secretin test using the criterion of an increase in gastrin of at least 110 pg/mL was 93% (CI, 76% to 99%) and for an increase of 200 pg/mL it was 85% (CI, 66% to 96%), (P greater than 0.05). With the calcium infusion test, the sensitivity using the criterion of an increase of 395 pg/mL was 43%, (CI, 23% to 66%) and for an increase of 50% was 74% (CI, 52% to 90%), (P less than 0.01). The calcium infusion test was positive in 33% of patients with a negative secretin test. With the secretin test, 75% of patients had a positive response by 5 minutes, 95% by 10 minutes, 100% by 15 minutes, and 6% only at 2 minutes. With calcium infusion, patients had positive responses at 120 to 180 minutes.


CONCLUSIONS
The secretin test is preferred over the calcium test because of its greater sensitivity and simplicity. The recommended criteria are a 200 pg/mL increase for the secretin test and a 395 pg/mL increase for the calcium test. The calcium test should be reserved for patients having a negative secretin test, gastric acid hypersecretion, and a strong clinical suspicion of the Zollinger-Ellison syndrome.
Frucht
H
H
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Howard
J M
JM
Slaff
J I
JI
Wank
S A
SA
McCarthy
D M
DM
Maton
P N
PN
Vinayek
R
R
Gardner
J D
JD
Jensen
R T
RT
D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005215:Fasting / Q000097:blood; D005260:Female; D005755:Gastrins / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009377:Multiple Endocrine Neoplasia / Q000097:blood; D011446:Prospective Studies; D012633:Secretin; D012680:Sensitivity and Specificity; D013997:Time Factors; D015043:Zollinger-Ellison Syndrome / Q000097:blood / Q000175:diagnosis*
D005755:Gastrins; D012633:Secretin; D002118:Calcium