Prospective study of the ability of histamine, serotonin or serum chromogranin A levels to identify gastric carcinoids in patients with gastrinomas.
BACKGROUND
Chronic hypergastrinaemia causes gastric enterochromaffin cell proliferation and carcinoid tumours. The only reliable means to diagnose enterochromaffin cell changes/carcinoids is by biopsy.


OBJECTIVE
To assess whether serum histamine, chromogranin A or serotonin and urinary N-methylimidazoleacetic acid or 5-hydroxyindoleacetic acid correlate with advanced enterochromaffin cell changes or gastric carcinoids in patients with gastrinomas.


METHODS
Consecutive patients (n=145) had the above assays and endoscopy with gastric biopsies.


RESULTS
Lower N-methylimidazoleacetic acid and chromogranin A levels (P < 0.0001) occurred in disease-free patients. In patients with active disease, the fasting serum gastrin levels correlated (P < 0.0001) with both chromogranin A and N-methylimidazoleacetic acid levels. Chromogranin A (P=0.005), but not N-methylimidazoleacetic acid, serotonin, 5-hydroxyindoleacetic acid or histamine levels, correlated with the enterochromaffin cell index. Carcinoids, but not advanced enterochromaffin cell changes only, were associated with higher chromogranin A and N-methylimidazoleacetic acid levels.


CONCLUSIONS
Serum chromogranin A levels and urinary N-methylimidazoleacetic acid levels, but not serum histamine or serotonin or urinary 5-hydroxyindoleacetic acid, correlate with the presence of gastric carcinoids. However, no assay identified patients with advanced enterochromaffin cell changes only with high sensitivity/specificity. Thus, N-methylimidazoleacetic acid and chromogranin A levels are unable to identify patients with advanced changes in enterochromaffin cells and therefore neither can replace routine gastric biopsies.
Bashir
S
S
Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1804, USA.
Gibril
F
F
Ojeaburu
J V
JV
Asgharian
B
B
Entsuah
L K
LK
Ferraro
G
G
Crafa
P
P
Bordi
C
C
Jensen
R T
RT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000097:blood / Q000652:urine; D001706:Biopsy; D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000473:pathology; D053379:Chromogranin A; D002864:Chromogranins / Q000097:blood; D005260:Female; D015408:Gastrinoma / Q000097:blood / Q000378:metabolism* / Q000652:urine; D006632:Histamine / Q000097:blood; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000652:urine; D007093:Imidazoles / Q000652:urine; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D009363:Neoplasm Proteins / Q000097:blood; D010190:Pancreatic Neoplasms / Q000097:blood / Q000378:metabolism* / Q000652:urine; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012701:Serotonin / Q000097:blood; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015043:Zollinger-Ellison Syndrome / Q000378:metabolism
D014408:Biomarkers, Tumor; C506150:CHGA protein, human; D053379:Chromogranin A; D002864:Chromogranins; D007093:Imidazoles; D009363:Neoplasm Proteins; C002667:methylimidazoleacetic acid; D012701:Serotonin; D006897:Hydroxyindoleacetic Acid; D006632:Histamine