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Z Gastroenterol 2009; 47(7): 671-673
DOI: 10.1055/s-0028-1109174
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© Georg Thieme Verlag KG Stuttgart · New York

Case Report: Extreme CgA Elevation Under PPI Confounding Assessment of Adrenal Mass

Fallbericht: Extreme CgA-Erhöhung unter einem PPI beeinflusst NebennierentumordiagnostikM. W. Wiedmann1 , J. Mössner2 , M. Stumvoll3 , D. Führer3
  • 1Abteilung Innere I, St.-Marien-Krankenhaus Berlin
  • 2Klinik und Poliklinik für Innere Medizin II, Universität Leipzig
  • 3Klinik und Poliklinik für Innere Medizin III, Universität Leipzig
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Publication History

manuscript received: 19.10.2008

manuscript accepted: 14.1.2009

Publication Date:
15 July 2009 (online)

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Zusammenfassung

Die Bestimmung des Chromogranin-A-Spiegels (CgA-Spiegel) im Blut kann für das Monitoring von neuroendokrinen Tumoren verwendet werden. CgA kann aber auch bei verschiedenen anderen endokrinen und nicht endokrinen Erkrankungen erhöht sein. Wir berichten über einen Patienten mit einem zufällig entdeckten Tumor der linken Nebenniere und einem erhöhten CgA-Spiegel. Die Adrenalektomie bestätigte nicht die vermutete Diagnose eines Phäochromozytoms. Postoperativ fiel ein weiterhin erhöhter CgA-Spiegel auf, der die Vermutung eines weiteren neuroendokrinen Tumors nahe legte, welche trotz einer umfangreichen Diagnostik nicht bestätigt werden konnte. Schließlich wurde entdeckt, dass eine kontinuierliche Protonenpumpenhemmereinnahme wegen einer Refluxösophagitis einen falsch erhöhten CgA-Spiegel verursacht hatte.

Abstract

Measurement of chromogranin A (CgA) level in blood can be used to monitor neuroendocrine tumours. However CgA level may also be elevated in several other endocrine and non-endocrine diseases. Here, we report on a patient with an incidental left-sided adrenal tumour and elevated CgA level. Adrenalectomy did not confirm clinically suspected diagnosis of pheochromocytoma. Postoperative follow-up was remarkable for a persistently elevated CgA level suspecting another neuroendocrine tumour which could not be detected despite extensive investigations. Finally, it was discovered that continuous proton-pump inhibitor administration for gastro-oesophageal reflux disease had caused a falsely elevated CgA level.

Schlüsselwörter

Protonenpumpenhemmer - Chromogranin A - neuroendokriner Tumor

Key words

proton-pump inhibitor - chromogranin A - adrenal incidentaloma

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PD Dr. Marcus Wolf Wiedmann

Abteilung Innere I, St.-Marien-Krankenhaus Berlin

Gallwitzallee 123 – 143

12249 Berlin

Germany

Phone: ++ 49/30/76 78 32 50

Fax: ++ 49/30/76 78 34 25

Email: wiedmann@marienkrankenhaus-berlin.de