Diagnostic value of serum chromogranin-A combined with MIBG scintigraphy in patients with adrenal incidentalomas

Luca Giovanella, L. Ceriani, M. Balerna, F. Keller, M. Taborelli, C. Marone, D. Ferone

Research output: Contribution to journalArticlepeer-review

Abstract

Aim. Adrenal incidentalomas (AI) are defined as asymptomatic adrenal masses occasionally discovered during high-resolution imaging procedures, as computed tomography or magnetic resonance. Pheochromocytoma, a chromaffin tumor, must be excluded before any invasive diagnostic or therapeutic procedure, in order to avoid dangerous acute catecholamines-release into bloodstream. Chromogranin-A (CgA) is a member of the granin family contained in secretory vesicles of chromaffin adrenal cells. Consequently, serum CgA increases in patients affected by pheochromocytoma and other diseases of the chromaffin system. This study investigated the performance of serum CgA in detecting or excluding pheochromocytoma, among patients with AI. Metbods. We enrolled 348 patients affected by AI > 20 mm without clinical or biochemical signs for corticosteroids overproduction. Serum CgA was assayed by a specific immunoradiometric method and a [123I]metaiodobenzylguanidine (MIBG) scan was performed in the 39 CgA-positive patients. Results. Eighteen out of these patients showed a positive scan and were submitted to laparoscopic adrenalectomy. Pheochromocytoma was histologically confirmed in all cases. The patients with positive serum CgA, but negative scan, as well as those with negative serum CgA, were reassessed 1 year later by clinical examination and serum CgA assay. None of patients developed clinical symptoms of chromaffin-tissue hyperactivity, nor showed a serum CgA increase. Serum levels of CgA were significantly higher in patients with pheochromocytoma than in patients without (P 20 mm. Particularly, a negative serum CgA assay may be used to rule out [123I]MIBG imaging and/or other diagnostic procedures.

Original languageEnglish
Pages (from-to)84-88
Number of pages5
JournalQuarterly Journal of Nuclear Medicine and Molecular Imaging
Volume52
Issue number1
Publication statusPublished - Mar 2008

Keywords

  • Adrenal gland neoplasms
  • Catecholamines
  • Chromogranin A
  • Iodine
  • M iodobenzyl-guanidine
  • Pheochromocytoma
  • Scintigraphy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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