Diagnostic accuracy of chromogranin A and calcitonin precursors measurements for the discrimination of ectopic ACTH secretion from Cushing's disease Export

@article{citeulike:4681366, abstract = {Context: Inferior petrosal sinus sampling (IPSS) best discriminates between the two causes of ACTH-dependent Cushing's syndrome, Cushing's disease (CD) and ectopic ACTH secretion (EAS). However, when sampling is not available, adjunctive diagnostic tests might be helpful. Neuroendocrine tumors may secrete chromogranin A (CgA), calcitonin (CT), procalcitonin (ProCT), a fragment of the amino terminus of procalcitonin (NProCT), and/or ACTH.Objective: To evaluate the ability of serum CgA, CT, ProCT or NProCT values to distinguish CD from EAS.Design: Prospective pilot studySettings: Clinical research centerSubjects and Methods: Serum ProCT, NProCT, and CgA were measured in six patients with occult EAS diagnosed by IPSS, 25 CD patients and eleven with histologically proven EAS.Results: Nine EAS patients (53\%) had at least one value above the reference range, including CgA alone (n = 4), ProCT alone (n = 3), CgA and ProCT (n = 1), and NProCT and ProCT (n = 1). Of nine (36\%) CD patients with one or two abnormal values, seven had increased ProCT only, one had increased NProCT only and one had increased CgA and ProCT. CgA had a positive predictive value of 83\% and a negative predictive value of 70\% for the diagnosis of EAS; other markers showed less discrimination. On pituitary MRI, no EAS patient had an abnormality while 21/25 patients with CD had a mass.Conclusion: These preliminary results suggest that an abnormal CgA and normal pituitary MRI favor the diagnosis of EAS, but normal tumor markers do not exclude the diagnosis. 10.1210/jc.2009-0604}, author = {Zemskova, Marina S. and Nylen, Eric S. and Patronas, Nicholas J. and Oldfield, Edward H. and Becker, Kenneth L. and Nieman, Lynnette K.}, citeulike-article-id = {4681366}, citeulike-linkout-0 = {http://dx.doi.org/10.1210/jc.2009-0604}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19470624}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19470624}, day = {26}, doi = {10.1210/jc.2009-0604}, journal = {J Clin Endocrinol Metab}, keywords = {cushing, diagnosis, neuroendocrine}, month = {May}, pages = {jc.2009-0604+}, posted-at = {2009-05-30 16:42:14}, priority = {2}, title = {Diagnostic accuracy of chromogranin A and calcitonin precursors measurements for the discrimination of ectopic ACTH secretion from Cushing's disease}, url = {http://dx.doi.org/10.1210/jc.2009-0604}, year = {2009} }

TY - JOUR ID - citeulike:4681366 L3 - citeulike-article-id:4681366 N2 - Context: Inferior petrosal sinus sampling (IPSS) best discriminates between the two causes of ACTH-dependent Cushing's syndrome, Cushing's disease (CD) and ectopic ACTH secretion (EAS). However, when sampling is not available, adjunctive diagnostic tests might be helpful. Neuroendocrine tumors may secrete chromogranin A (CgA), calcitonin (CT), procalcitonin (ProCT), a fragment of the amino terminus of procalcitonin (NProCT), and/or ACTH.Objective: To evaluate the ability of serum CgA, CT, ProCT or NProCT values to distinguish CD from EAS.Design: Prospective pilot studySettings: Clinical research centerSubjects and Methods: Serum ProCT, NProCT, and CgA were measured in six patients with occult EAS diagnosed by IPSS, 25 CD patients and eleven with histologically proven EAS.Results: Nine EAS patients (53%) had at least one value above the reference range, including CgA alone (n = 4), ProCT alone (n = 3), CgA and ProCT (n = 1), and NProCT and ProCT (n = 1). Of nine (36%) CD patients with one or two abnormal values, seven had increased ProCT only, one had increased NProCT only and one had increased CgA and ProCT. CgA had a positive predictive value of 83% and a negative predictive value of 70% for the diagnosis of EAS; other markers showed less discrimination. On pituitary MRI, no EAS patient had an abnormality while 21/25 patients with CD had a mass.Conclusion: These preliminary results suggest that an abnormal CgA and normal pituitary MRI favor the diagnosis of EAS, but normal tumor markers do not exclude the diagnosis. 10.1210/jc.2009-0604 JF - J Clin Endocrinol Metab TI - Diagnostic accuracy of chromogranin A and calcitonin precursors measurements for the discrimination of ectopic ACTH secretion from Cushing's disease SP - jc.2009-0604 KW - cushing KW - diagnosis KW - neuroendocrine AU - Zemskova, Marina AU - Nylen, Eric AU - Patronas, Nicholas AU - Oldfield, Edward AU - Becker, Kenneth AU - Nieman, Lynnette PY - 2009/05/26/ UR - http://dx.doi.org/10.1210/jc.2009-0604 ER -