title: High plasma levels of human chromogranin A and adrenomedullin in patients with pheochromocytoma.
abstract: OBJECTIVE
  The aim of our study was to investigate the plasma chromogranin A (CgA) and adrenomedullin (AM) levels in patients with pheochromocytomas.
  
  
  METHODS
  We collected blood samples for measurement of plasma CgA and AM in 21 patients with pheochromocytomas, 43 healthy subjects and 26 patients with solid non-functioning adrenocortical adenomas. In 11 patients with pheochromocytomas plasma CgA and AM were measured again four weeks after tumor removal. CgA and AM were measured by means of a novel solid-phase two-site immunoradiometric assay based on monoclonal antibodies (CgA-RIA CT, CIS bio international) and by a specific radioimmunoassay (RIA, Phoenix Pharm. Inc.), respectively.
  
  
  RESULTS
  The mean plasma CgA level (+/- SD) in patients with pheochromocytomas (204 +/- 147.9 ng/mL) was significantly higher (P < 0.001) than that in healthy subjects (41.6 +/- 10.7 ng/mL) and in patients with non-functioning adrenocortical adenomas (47.3 +/- 17.6 ng/mL). The mean plasma AM concentration (+/- SD) in patients with pheochromocytomas (27.5 +/- 10.4 pg/mL) was significantly higher (P < 0.001) than that in HS (13.8 +/- 4.5 pg/mL) and in patients with non-functioning adrenocortical adenomas (16.6 +/- 7.3 pg/mL). Plasma CgA levels correlated with plasma AM levels (r = 0.501; P < 0.02) and with plasma metanephrine levels (r = 0.738; P < 0.0001) in patients with pheochromocytomas. In 11 patients with pheochromocytomas plasma CgA and AM concentrations significantly decreased after tumor removal (P < 0.001 for both). Circulating CgA and AM had a sensitivity of 76.2% and 81%, a specificity of 97.7% and 90.7%, and an accuracy of 91% and 88%, respectively.
  
  
  CONCLUSIONS
  This study demonstrates that circulating CgA and AM levels are increased in pheochromocytoma patients compared with healthy subjects and patients with non-functioning adrenocortical adenomas. Moreover, at the time of diagnosis plasma CgA levels correlated with plasma AM levels and with plasma metanephrine levels in all patients with pheochromocytomas. In conclusion, plasma CgA and AM concentrations may represent additional biochemical parameters for clinical monitoring of patients with pheochromocytomas.
authors.affiliation: Department of Clinical Sciences, University of Rome La Sapienza, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Cotesta
authors.forename: Chiara
authors.initials: C
authors.lastname: Caliumi
authors.forename: Piero
authors.initials: P
authors.lastname: Alò
authors.forename: Luigi
authors.initials: L
authors.lastname: Petramala
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Reale
authors.forename: Raffaele
authors.initials: R
authors.lastname: Masciangelo
authors.forename: Alberto
authors.initials: A
authors.lastname: Signore
authors.forename: Rosario
authors.initials: R
authors.lastname: Cianci
authors.forename: Emilio
authors.initials: E
authors.lastname: D'Erasmo
authors.forename: Claudio
authors.initials: C
authors.lastname: Letizia
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood; D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000737:chemistry; D018246:Adrenocortical Adenoma / Q000097:blood; D053607:Adrenomedullin; D000328:Adult; D000911:Antibodies, Monoclonal; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood* / Q000276:immunology; D053379:Chromogranin A; D002864:Chromogranins / Q000032:analysis / Q000097:blood* / Q000276:immunology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000032:analysis / Q000097:blood* / Q000276:immunology; D010673:Pheochromocytoma / Q000097:blood* / Q000737:chemistry; D011863:Radioimmunoassay; D012680:Sensitivity and Specificity; D014018:Tissue Distribution
chemical_list: D000911:Antibodies, Monoclonal; D014408:Biomarkers, Tumor; C506150:CHGA protein, human; D053379:Chromogranin A; D002864:Chromogranins; D010455:Peptides; D053607:Adrenomedullin