Clinical significance of elevated serum chromogranin A levels

Background. Prostate-specific antigen (PSA ) is predominantly produced by prostate epithelium, however, other tissues can serve as its minor sources in both men and women, including breast tissue. In women, elevated serum PSA levels have been described in different physiological and pathological conditions, including benign breast diseases and breast cancer (BC). PSA is considered as a potential serum tumor marker for BC, but evidences of its possible clinical significance are insufficiently convincing.Aim of the study: investigation of PSA levels in female BC patients and assessment of perspectives of its study as a diagnostic tool for early detection of BC.Material and methods. Serum PSA levels were measured by chemiluminescence immunoassay (ARCHITECT , Abbott) in 99 female patients with histologically confirmed BC (carcinoma in situ – 11, stage I – 56, stage IIA – 32) and 25 conditionally healthy female donors.Results. In the donor group, serum PSA was revealed in 22/25 (88,0 %) cases, and its mean level was 4.0 ± 0.9 ng/l. In the group of BC patients, detectable PSA level was revealed in 68/99 (68.7 %) cases, and its mean level was 2.8 ± 0.9 ng/l. Differences between groups of BC patients and donors in mean marker values were not statistically significant (p>0,05). Serum PSA levels were higher in young women: in the group of BC patients under 40 years old, percentage of PSA -positive cases was 89 %, in the group of patients over 50 years old – 60 %; in groups of donors under 40 and over 50 years old – 100 % and 80 %, respectively. In cases of in situ carcinoma, the mean serum PSA was higher than in cases with stages I and II (3.0 ± 1.2 ng/l vs 1.9 ± 0.3 ng/l and 1.6 ± 0.3 ng/l, respectively; p>0,05). In the group of BC patients, no PSA levels were found to be dependent on the histological type, grade and molecular subtype of the tumor.Conclusion. The PSA level has no clinical significance in early stages of BC, since the proportion of cases with elevated PSA levels and it’s mean value in patients with early stages of BC don’t differ from those in the group of healthy women.

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Serum chromogranin A in the differential diagnosis of Cushing's syndrome

Acta Endocrinologica ◽

10.1530/eje.0.1310589 ◽

1994 ◽

Vol 131 (6) ◽

pp. 589-593 ◽

Cited By ~ 20

Author(s):

Frank RE Nobels ◽

Wouter W de Herder ◽

Dik J Kwekkeboom ◽

Willy Coopmans ◽

Andries Mulder ◽

...

Keyword(s):

Differential Diagnosis ◽

Cushing’S Syndrome ◽

Immunohistochemical Staining ◽

Chromogranin A ◽

Neuroendocrine Tumours ◽

Elevated Serum ◽

Serum Levels ◽

Cushing's Syndrome ◽

Ectopic Acth ◽

Adrenocortical Tumour

Nobels FRE, de Herder WW, Kwekkeboom DJ, Coopmans W, Mulder A, Bouillon R, Lamberts SWJ. Serum chromogranin A in the differential diagnosis of Cushing's syndrome. Eur J Endocrinol 1994:131:589–93. ISSN 0804–4643 We evaluated whether measuring serum levels of chromogranin A, a marker of neuroendocrine tumours, could be useful in the differential diagnosis between pituitary, adrenal and ectopic causes of Cushing's syndrome. Thirty patients with Cushing's syndrome were studied. The localization of the tumours responsible was pituitary in 15, adrenal in 5 and ectopic in 10 patients. Serum concentrations of chromogranin A were measured in all patients. Petrosal sinus sampling for chromogranin A was performed in the cases with pituitary-dependent Cushing's syndrome. Immunohistochemical staining for chromogranin A was carried out on part of the tumour specimens. Slightly elevated serum levels of chromogranin A (range 223–262 μg/1) were detected in inferior petrosal sinus and peripheral venous samples from three patients with pituitary-dependent Cushing's syndrome. Serum chromogranin A showed no significant pituitary to peripheral gradient in these patients. Chromogranin A levels were not elevated in cases of adrenal Cushing's syndrome. Markedly elevated concentrations (range 270–13900 μg/1) were shown in seven of 10 patients with neuroendocrine tumours with ectopic adrenocorticotrophin (ACTH) and/or corticotrophin-releasing hormone (CRH) production. Widespread metastasis was present in all these cases. Subjects with "occult" carcinoid tumours, with limited spread, had normal chromogranin A levels Immunohistochemical staining for chromogranin A was positive in three out of five pituitary adenomas and in all neuroendocrine tumours with ectopic ACTH and/or CRH production, while it was negative in all adrenocortical tumour specimens. It is concluded that elevated serum levels of chromogranin A can serve as markers of neuroendocrine tumours with ectopic ACTH and/or CRH production. The circulating levels are dependent mainly on the size of the tumours. Serum chromogranin A is not useful in the diagnosis of so-called occult Cushing's syndrome, caused by ectopic ACTH and/or CRH secretion by small neuroendocrine tumours. F Nobels, Department of Endocrinology, Onze Lieve Vrouw Hospital, 164 Moorselbaan, 9300 Aalst, Belgium

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