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Chromogranin A belongs to the family of protein know as grains that are mostly produced by hormone and neuroendocrine cells . Therefore , it is an accepted biomarker for the assessment of neuroendocrine tumor . In the past , it was used in the management of patients with neoplasm of the gastroenteropancreatic line of descent . However , recently , it has been associate with various other status , include both benign and malignant . The sensitivity and specificity of chromogranin A in all of these conditions take issue significantly that depends on various factors ; therefore , its use is limited as an effectual prognostic and prognostic biomarker for a narrow-minded spectrum of conditions and diseases . It is specifically used as a biomarker in oncology.(1 )
What Causes Elevated Chromogranin A Levels?
Non - Neuroendocrine Tumors
There are various causes of elevated chromogranin A ( CgA ) levels that are unrelated to neuroendocrine tumor . The most rough-cut causes of non - neuroendocrine tumors ( delusive - positive result ) encountered in the clinical practice is the use of proton pump inhibitors ( PPIs ) , atrophic gastritis type and impaired kidney function.(2 )
The economic consumption of proton heart inhibitor and other virulent - suppressive medications stimulate the growth of enterochromaffin mobile phone to release CgA result in noble-minded level of CgA in circulation . PPIs lead to increased assiduousness , about 5 - 10 times of CgA within 5 day of medicine uptake , which is seen in the early phase of neuroendocrine neoplasm . Histamine type-1 sense organ antagonist are also related to increasing in CgA grade . Kidney nonstarter and reduced nephritic clearance also lead to sublime levels of CgA.
Chronic heart loser is also associated with increased level of CgA and the levels are relate to the intensity ofheart failure.(2 )
Other causes of lofty levels of CgA include hypertension , inflammatory intestine disease , irritable gut syndrome , pancreatitis , chronic hepatitis , liver cirrhosis , systemicrheumatoid arthritis , systemic lupus erythematosus , chronic clogging pulmonary disease , Parkinson ’s disease , steroid hormone treatment , food inspiration or strenuous practice session before a test.(2 )
Non - neuroendocrine tumors that can lead to raised stage of CgA include prostate gland cancer , ovarian cancer , knocker malignant neoplastic disease , colorectal cancer , pancreatic cancer , hepatocellular carcinoma , and hematologic malignancies . The raised horizontal surface of CgA in prostate malignant neoplastic disease are related to progression , short medical prognosis and impedance to hormonal therapy . The elevated story of CgA can not be used to evaluate the severity or progression of disease in non - neuroendocrine neoplasm as the neoplasm size does not correlate with tumour size of it or disease progression.(2 )
Neuroendocrine Tumors
The neuroendocrine neoplasms , such as phaeochromocytoma , parathyroid adenomas , medullary thyroid gland malignant neoplastic disease , pituitary neoplasm ( except prolactinomas ) , pulmonary neuroendocrine tumors include small cell lung Cancer the Crab and gastroenteropancreatic neuroendocrine neoplasm ( GEP - NETs ) secrete CgA. Therefore , the elevated concentration of chromogranin A is used as a marker of tumors in unlike disease . A 100 % aggrandizement of CgA is see in gastrinomas , 89 % in pheochromocytomas , 80 % in neuroendocrine tumour of the small bowel , 69 % in non - functioning pancreatic neuroendocrine tumor , and > 50 % in medullary thyroid cancer.(2 )
CgA is the recommended first - line marker of GEP - NETs . It is significant in the diagnosis , prognosis , clinical rating after cytoreductive surgery , and follow up of these tumors . The GEP - NETs that secrete CgA are link up with increased neoplasm burden and recurrence as well as a marker of misfortunate prognosis and reduced survival of the fittest in ileal and pancreatic neuroendocrine tumors . The reduction in CgA levels has also been used as a marker of reply to discussion . The high level of CgA are seen in affected role with function ileal neuroendocrine neoplasm and carcinoid syndrome along with liver metastases . metastasis to lymph thickening do not make substantial elevation of CgA levels.(1 )
The sensitivity and specificity of CgA for various neuroendocrine tumors vagabond from 60 - 100 % and 70 - 100 % , severally , and the high economic value is keep for 5-hydroxytryptamine - secreting neuroendocrine tumors ( carcinoid tumor ) . Caution should be kept in mind during the interpretation of chromogranin A as various constituent can lead to imitation - positivistic as well as untrue - minus results . The majuscule value of CgA as a mark of the disease can be seen in metastatic disease to the liver.(2 )
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