Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 67
Filtrar
Mais filtros

País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
Endocr J ; 67(3): 305-315, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-31813923

RESUMO

The appropriate localization of gastrinoma is still difficult. We aimed to evaluate the diagnostic accuracy of selective arterial calcium injection (SACI) for localization of gastrinomas including multiple lesions. This retrospective study included ten patients with surgically proven gastrinomas (gastrinoma group) and six patients without any findings suggesting Zollinger-Ellison syndrome (non-gastrinoma group). For SACI, calcium gluconate was injected into the arteries supplying pancreas, duodenum, and liver. Blood samples from the hepatic vein were obtained before and 30, 60, and 120 seconds after each injection. The results were considered positive when the increase in serum immunoreactive gastrin (IRG) levels within 60 seconds of calcium gluconate injection were more than 80 pg/mL and more than 20% from baseline. We evaluated the efficacy of SACI by comparing the SACI responses with definitive locations diagnosed by clinical and histopathological findings. In the gastrinoma group, false-positive responses were confirmed in seven of the ten patients. False-negative response was observed in one of the feeding arteries of one patient with gastrinomas in multiple locations. Conversely, the greatest increase in serum gastrin levels from baseline at 30 seconds indicated the true-positive responses in all patients with gastrinomas. In the non-gastrinoma group, calcium gluconate injection into gastroduodenal artery evoked positive responses in five of the six patients. In conclusion, our data suggest the strongest gastrin response evoked by SACI indicates the definitive location in patients with gastrinomas. In contrast, SACI could not accurately locate multiple gastrin-secreting lesions due to poor specificity.


Assuntos
Gluconato de Cálcio , Gastrinoma/diagnóstico , Gastrinas/sangue , Neoplasias Pancreáticas/diagnóstico , Idoso , Artérias , Feminino , Gastrinoma/sangue , Gastrinoma/patologia , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos
2.
Surg Today ; 43(11): 1281-5, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22983734

RESUMO

INTRODUCTION: The glucagon provocative test is useful for the diagnosis of gastrinoma. The aim of this study was to determine the criteria for the glucagon provocative test. METHODS: This study reviewed 8 patients that underwent the glucagon provocative test preoperatively and in whom the diagnosis was confirmed as gastrinoma histologically. The glucagon provocative test was performed by administering glucagon (20 µg/kg) intravenously, followed by 20 µg/kg h for the next 30 min, and plasma gastrin levels were measured 3 and 1 min before and 3, 5, 7, 10, 15, 20, and 30 min after the administration of glucagon. This study evaluated the peak value of plasma gastrin and the time required to reach the peak. RESULTS: Two of the 8 patients had multiple endocrine neoplasm type 1. The basal plasma gastrin levels ranged from 524 to 10,300 pg/ml. The time required to reach the peak was 3-10 min for all patients. The increase in the peak from the basal value was 235-8,920 pg/ml, and the percentage of increase was 38-337 %. CONCLUSIONS: These results suggest that a diagnosis of gastrinoma should thus be made when plasma gastrin levels peak within 10 min after glucagon administration, with an increase of greater than 200 pg/ml and greater than 35 % of the basal value.


Assuntos
Biomarcadores Tumorais/sangue , Gastrinoma/diagnóstico , Gastrinas/sangue , Glucagon , Testes de Função Pancreática/métodos , Neoplasias Pancreáticas/diagnóstico , Idoso , Feminino , Gastrinoma/sangue , Glucagon/administração & dosagem , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Fatores de Tempo
3.
J Cancer Res Clin Oncol ; 148(3): 697-706, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33904982

RESUMO

PURPOSE: In patients with metastatic functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), it is unknown what degree of tumor reduction is required to eliminate hormonal symptoms. We aimed to reduce hormonal symptoms derived from advanced GEP-NENs by efficient minimal intervention, constructing a hormonal tumor map of liver metastases. METHODS: Between 2013 and 2019, we treated 12 insulinoma or gastrinoma patients with liver metastases. Liver segments containing hormone-producing tumors were identified by injecting calcium gluconate via the hepatic arteries and monitoring the change in serum hormone concentration in the three hepatic veins. A greater-than-twofold increase in hormone concentration indicated a tumor-feeding vessel. RESULTS: Cases included eight insulinomas and four gastrinomas. Primary lesions were functional in three patients and nonfunctional in 9. Nine patients showed hormonal step-up indicating the presence of functional lesions; eight showed step-up in tumor-bearing liver segments, while one with synchronous liver metastases showed step-up only in the pancreatic region. Five patients underwent surgery. Serum hormone concentration decreased markedly after removing the culprit lesions in 3; immediate improvement in hormonal symptoms was achieved in all patients. Three patients with previous surgical treatment who showed step-up underwent transcatheter arterial embolization, achieving temporary improvement of hormonal symptoms. Four patients showed unclear localization of the hormone-producing tumors; treatment options were limited, resulting in poor outcomes. CONCLUSION: Hormonal tumor mapping demonstrated heterogeneity in hormone production among primary and metastatic tumors of GEP-NENs. Minimally invasive treatment based on hormonal mapping may be a viable alternative to conventional cytoreduction.


Assuntos
Gastrinoma/patologia , Hormônios/sangue , Insulinoma/patologia , Neoplasias Intestinais/patologia , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Feminino , Seguimentos , Gastrinoma/sangue , Gastrinoma/cirurgia , Humanos , Insulinoma/sangue , Insulinoma/cirurgia , Neoplasias Intestinais/sangue , Neoplasias Intestinais/cirurgia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/sangue , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/cirurgia
4.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31919513

RESUMO

CONTEXT: Helicobacter pylori and Multiple Endocrine Neoplasia Type 1 (MEN 1) are risk factors for hypergastrinemia. Gastrin-secreting neoplasms of the foregut mucosa are both a source of, and potentially stimulated by, hypergastrinemia. OBJECTIVE: To determine the relationship between H pylori exposure and the prevalence and severity of hypergastrinemia in patients with MEN 1. DESIGN, SETTING & PATIENTS: Cross-sectional analysis of patients with a common MEN1 gene mutation managed at a tertiary referral hospital that underwent fasting serum gastrin and H pylori serum IgG measurement. INTERVENTION: H pylori IgG and serum gastrin concentration, determined via immunoassay. MAIN OUTCOME MEASURES: The prevalence and severity of hypergastrinemia and its relationship to past H pylori exposure. RESULTS: Thirty-four of 95 (36%) patients were H pylori IgG seropositive. H pylori seropositive patients were significantly more likely to exhibit hypergastrinemia compared with seronegative patients (relative risk [RR] 1.72, P = .023). H pylori exposure also predicted severe hypergastrinemia (RR 3.52, P = .026 and RR 9.37, P = .031 for patients with gastrin ≥ ×4 and ≥ ×8 the upper limit of normal [ULN], respectively). Gastrin concentrations ≥ ×10 ULN occurred exclusively in H pylori seropositive patients (0/61 vs 6/34, P = .001). Serum gastrin and alpha subunit were positively associated in H pylori-exposed (ß = 0.69, P = .001), but not in H pylori-unexposed patients. CONCLUSION: Past H pylori exposure was associated with increased prevalence and severity of hypergastrinemia in MEN 1 patients. Past H pylori-related hypergastrinemia may contribute to the pathogenesis of ongoing gastrin hypersecretion by susceptible foregut neuroendocrine tissues.


Assuntos
Gastrinoma/epidemiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Neoplasia Endócrina Múltipla Tipo 1/epidemiologia , Neoplasias Pancreáticas/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Gastrinoma/sangue , Gastrinoma/complicações , Gastrinoma/patologia , Gastrinas/sangue , Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/patologia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Prevalência , Índice de Gravidade de Doença , Tasmânia/epidemiologia , Adulto Jovem
5.
ScientificWorldJournal ; 9: 501-4, 2009 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-19578706

RESUMO

We present a rare case of renal gastrinoma. To the best of our knowledge, only one case of renal gastrinoma has been reported in the literature so far. An African American male was diagnosed with Zollinger Ellison syndrome at the age of 15 years, when he underwent surgery for peritonitis secondary to duodenal ulcer perforation. Further evaluation was deferred and proton pump inhibitors were prescribed. Later evaluation showed a left renal mass. Serum gastrin levels were 4,307 pg/ml. A CAT scan of the abdomen showed 4- x 4-cm heterogeneous solid mass in the interpolar region of the left kidney with central hypodensity. Somatostatin scintigraphy confirmed a receptor-positive mass in the same location. Nephrectomy was done and the tumor was diagnosed on histopathological examination as a gastrinoma. At 6-month follow-up, gastrin levels were 72 pg/ml. After a follow-up of 6 years, the patient has no recurrent symptoms.


Assuntos
Gastrinoma/patologia , Neoplasias Renais/patologia , Síndrome de Zollinger-Ellison/patologia , Adolescente , Diagnóstico Diferencial , Gastrinoma/sangue , Gastrinoma/cirurgia , Gastrinas/sangue , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Neoplasias Renais/sangue , Neoplasias Renais/cirurgia , Masculino , Nefrectomia , Tomografia Computadorizada por Raios X
6.
Hepatogastroenterology ; 55(88): 2224-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19260510

RESUMO

Primary hepatic gastrinoma is very rare, with fewer than 20 cases reported. We describe a 44-year-old woman in whom primary hepatic gastrinoma was strongly suspected clinically. The patient was referred to our hospital because of intractable diarrhea. She had elevated serum levels of alanine aminotransferase, aspartate aminotransferase, and fasting gastrin. A calcium provocative test showed a marked elevated serum gastrin level (17,000 pg/ml). Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed a tumor in the right lobe of the liver, measuring 38 x 33 mm. No other tumor was detected in the pancreas, duodenum, or local lymph nodes on preoperative radiological imaging or endoscopic ultrasonography. The hepatic tumor was resected. Total intraoperative ultra-sonography and intraoperative exploratory palpation of the duodenum, pancreas, and lymph nodes showed no evidence of an extrahepatic tumor. Pathological findings and immunohistochemical studies revealed a neuroendocrine tumor with increased production of gastrin. Postoperatively, the serum gastrin level returned to normal.


Assuntos
Gastrinoma/cirurgia , Neoplasias Hepáticas/cirurgia , Adulto , Diagnóstico por Imagem , Feminino , Gastrinoma/sangue , Gastrinoma/diagnóstico , Gastrinas/sangue , Gastrinas/metabolismo , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico , Tomografia Computadorizada por Raios X
7.
J Endocrinol Invest ; 30(3): 241-6, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17505159

RESUMO

Previous experiments reported desensitization to SS action in rat anterior pituitary cells and cell lines. The aim of the study was to verify whether the lack of desensitization to SS analogs (SSa) observed in acromegalic patients was also present in subjects with normal hypothalamic-pituitary function. The effect of chronic treatment with octreotide long-acting release (o-LAR, 10-30 mg/28 days) on IGF-I levels was then evaluated in 23 patients with gastroenteropancreatic (GEP) endocrine tumors (8 gastrinomas, 6 carcinoids, and 9 functioning pancreatic tumors). Serum IGF-I, clinical symptoms, plasma chromogranin-A (CgA) and markers of hepatic synthesis were evaluated before and after a short-term period in all the patients (median 4.5 months), after a medium-term period in 12 (median 18 months) and after a long-term follow-up period in 9 of them (median 48 months). Mean IGF-I levels decreased from 17.3+/-7.0 to 12.8+/-6.2 nmol/l in the short-term (p<0.005) being reduced from baseline concentrations in 87% and under the normal range for age in 35% of patients. Afterwards, they always remained stable both in the medium- and long-term periods, still being low in 3/12 and 2/9 patients, respectively. No alterations in biochemical markers of liver function were found either before or during therapy. No correlation between IGF-I levels, CgA concentrations and/or clinical definitive outcome was observed. In conclusion, the study demonstrated that: a) similarly to that observed in acromegalic patients, chronic o-LAR treatment did not induce desensitization of pituitary SS receptors (SSR) in humans with intact hypothalamic-pituitary axis, and b) in patients with GEP endocrine tumors, GH/IGF-I inhibition did not contribute to SSa efficacy.


Assuntos
Gastrinoma/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Neoplasias Intestinais/tratamento farmacológico , Neoplasia Endócrina Múltipla/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Adulto , Idoso , Tumor Carcinoide/sangue , Tumor Carcinoide/tratamento farmacológico , Feminino , Gastrinoma/tratamento farmacológico , Humanos , Neoplasias Intestinais/sangue , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla/sangue , Neoplasias Pancreáticas/sangue , Tempo
8.
Wien Klin Wochenschr ; 119(19-20): 573-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985090

RESUMO

The Zollinger-Ellison syndrome is characterized pathophysiologically by a significant hypergastrinemia derived from a gastrin-secreting neuroendocrine tumor with a primary location in the pancreas or duodenum. Chronic hypergastrinemia in turn triggers gastric acid hypersecretion yielding in chronic or recurrent or refractory peptic ulcer disease and/or chronic diarrhea. One half of patients with ZES will have distant metastases in the liver by the time the diagnosis is established and one half of all patients with ZES will experience chronic diarrhea as chief complaint rather than peptic ulcer-related symptoms and signs. Gastrinomas have been reported to either manifest sporadically or to occur in conjunction with the genetic background of the MEN-I syndrome. Diagnosis is based on the patients history which is typically characterized by recurrent episodes of peptic ulcer disease or by severe reflux esophagitis and/or diarrhea or by acid-related symptoms which fail to respond to standard treatment regimens. Upper gastrointestinal tract endoscopy will provide evidence for peptic ulcer disease in anatomical regions located aborally the duodenal bulb within the descending part of the duodenum or even farther distally within the jejunum. Peptic ulcers frequently occur in groups indicating some substantial acid hypersecretion. A gastric pH > 2 is mutually exclusive for ZES. Increased serum gastrin levels confirm the diagnosis biochemically. Gastrin secretion can be determined in the basal state or following stimulation with secretin or calcium. High sensitivity and specificity for the diagnosis of ZES is provided by determining the ratio of basal versus pentagastrin-stimulated gastric acid secretion: The ratio of BAO / MAO > 0.6 is highly specific for gastrinoma. To localize the gastrin-secreting tumor computer-assisted tomography, endoscopic ultrasound, and somatostatin receptor scintigraphy provide useful help but most recently, endoscopic ultrasound with high resolution transducers appear to improve preoperative site localization. If modern imaging techniques fail to elucidate the site of the tumor, intraoperative diaphany may help to detect gastrinomas within the duodenal wall. Definitive treatment will only be achieved by total surgical resection of the gastrin-producing tumor in the pancreas or duodenum including dissection of the regional lymph nodes. Control of symptoms will have to be achieved by administration of highly potent proton pump inhibitors in up to 2-3-fold increased standard doses to inhibit gastric acid hypersecretion. Elevation of gastric pH > 4 will be the therapeutic target to protect the mucosa of the upper gastrointestinal tract. Basal acid output should be reduced to less than 10 mEq H(+) per hour which requires administration of highly potent proton pump inhibitors with a recommended starting dose of 60 mg omeprazole equivalents per day.


Assuntos
Neoplasias Duodenais/diagnóstico , Esofagite Péptica/tratamento farmacológico , Gastrinoma/diagnóstico , Gastrinas/sangue , Neoplasias Pancreáticas/diagnóstico , Úlcera Péptica/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Síndrome de Zollinger-Ellison/diagnóstico , Diagnóstico Diferencial , Neoplasias Duodenais/sangue , Neoplasias Duodenais/tratamento farmacológico , Esofagite Péptica/etiologia , Determinação da Acidez Gástrica , Gastrinoma/sangue , Gastrinoma/tratamento farmacológico , Humanos , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/tratamento farmacológico , Úlcera Péptica/etiologia , Síndrome de Zollinger-Ellison/sangue , Síndrome de Zollinger-Ellison/tratamento farmacológico
9.
Wien Klin Wochenschr ; 119(19-20): 593-6, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985094

RESUMO

Somatostatin receptor scintigraphy (SRS) is a valuable method for the detection of somatostatin receptor-positive lesions. Most gastrinomas (over-)express the somatostatin receptor subtype 2 which can be targeted by In-111 labeled Octreotide. Different studies show a high sensitivity of SRS for the localization and staging of gastrinomas. SRS seems to be superior to other non-invasive imaging modalities and has been proven to significantly contribute to patient management. However, the sensitivity depends on the size and exact localization of the tumors. Smaller lesions and lesions located in the duodenum show a significantly lower sensitivity. In any case, SRS belongs to the routine imaging procedure for gastrinomas for localization and staging and can also be used for evaluation of the tumor progression.


Assuntos
Neoplasias Duodenais/diagnóstico por imagem , Gastrinoma/diagnóstico por imagem , Gastrinas/sangue , Neoplasias Pancreáticas/diagnóstico por imagem , Receptores de Somatostatina/análise , Progressão da Doença , Neoplasias Duodenais/sangue , Neoplasias Duodenais/patologia , Gastrinoma/sangue , Gastrinoma/patologia , Humanos , Radioisótopos de Índio , Neoplasia Endócrina Múltipla Tipo 1/sangue , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico por imagem , Neoplasia Endócrina Múltipla Tipo 1/patologia , Estadiamento de Neoplasias , Octreotida , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/patologia , Cintilografia , Sensibilidade e Especificidade
10.
Wien Klin Wochenschr ; 119(19-20): 602-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985096

RESUMO

Gastrinoma is the most frequent functional pancreaticoduodenal endocrine tumor in patients with multiple endocrine neoplasia type 1 (MEN1) and one major determinant of mortality in this syndrome. Whether routine surgical exploration should be performed in a patient with MEN1 associated Zollinger-Ellison syndrome (ZES) to possibly reduce the malignant spread and eventually increase survival still remains controversial. There is not only disagreement about the indication for surgical exploration, but also what type of procedure should be performed, since sufficient evidence-based data are not available. The article discusses the available data on treatment strategies of MEN1 associated ZES.


Assuntos
Neoplasias Duodenais/cirurgia , Gastrinoma/cirurgia , Gastrinas/sangue , Neoplasia Endócrina Múltipla Tipo 1/cirurgia , Neoplasias Pancreáticas/cirurgia , Progressão da Doença , Neoplasias Duodenais/sangue , Neoplasias Duodenais/mortalidade , Gastrinoma/sangue , Gastrinoma/mortalidade , Humanos , Laparoscopia , Neoplasia Endócrina Múltipla Tipo 1/sangue , Neoplasia Endócrina Múltipla Tipo 1/mortalidade , Pancreatectomia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia , Prognóstico , Reoperação , Taxa de Sobrevida , Síndrome de Zollinger-Ellison/sangue , Síndrome de Zollinger-Ellison/mortalidade , Síndrome de Zollinger-Ellison/cirurgia
11.
Wien Klin Wochenschr ; 119(19-20): 597-601, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985095

RESUMO

Surgical therapy for sporadic gastrinoma profits from innovative pre- and intraoperative diagnostics. Preoperative gastrinoma localization is enhanced by sophisticated endoscopic ultrasonography, scintigraphic and arteriographic studies with hormone sampling. Thereby a concise surgical approach is guided and additional intraoperative control of success may be gained by endoscopic transillumination and measurement of stimulated gastrin levels.


Assuntos
Neoplasias Duodenais/cirurgia , Gastrinoma/cirurgia , Gastrinas/sangue , Neoplasias Pancreáticas/cirurgia , Diagnóstico por Imagem , Neoplasias Duodenais/sangue , Neoplasias Duodenais/diagnóstico , Gastrinoma/sangue , Gastrinoma/diagnóstico , Humanos , Período Intraoperatório , Neoplasias Primárias Múltiplas/sangue , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico , Prognóstico , Transiluminação , Síndrome de Zollinger-Ellison/sangue , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/cirurgia
12.
Wien Klin Wochenschr ; 119(19-20): 609-15, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985097

RESUMO

Gastrinomas are functional neuroendocrine tumors of the gastroenteropancreatic system. Surgery is first line treatment in gastrinomas, however often fails to be curative. This manuscript reviews current strategies of medical treatment of surgically non-curable gastrinoma. Symptomatic treatment with H(+)-K(+)-ATPase proton-pump inhibitors suppresses hypersecretion of gastric acid and substantially improves quality of life in patients with Zollinger-Ellison syndrome. Further medical therapy is only recommended in cases of progressive metastatic gastrinoma. In well differentiated neuroendocrine carcinoma (G1 and G2) a so-called biotherapy with somatostatin analogues exists as first-line and chemotherapy with streptocotozin plus doxorubicine/5-FU as second-line medical treatment option. In poorly differentiated neuroendocrine carcinoma (G3) chemotherapy with etoposide plus cisplatin is possible. Prospective future therapeutic strategies may include treatment with novel somatostatin analogues as well as angiogenesis inhibitors and kinase inhibitors targeting tumor-specific signaling cascades.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Duodenais/tratamento farmacológico , Gastrinoma/tratamento farmacológico , Gastrinas/sangue , Neoplasias Pancreáticas/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Somatostatina/análogos & derivados , Síndrome de Zollinger-Ellison/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Ensaios Clínicos como Assunto , Neoplasias Duodenais/sangue , Gastrinoma/sangue , Humanos , Interferon-alfa/uso terapêutico , Octreotida/uso terapêutico , Neoplasias Pancreáticas/sangue , Peptídeos Cíclicos/uso terapêutico , Somatostatina/uso terapêutico , Síndrome de Zollinger-Ellison/sangue
13.
Wien Klin Wochenschr ; 119(19-20): 564-9, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985088

RESUMO

The most frequent conditions of hypergastrinemia in man are the Zollinger-Ellison syndrome with autonomous gastrin hypersecretion by the tumour cell and reactive hypergastrinemia in type A autoimmune chronic atrophic gastritis with achlorhydria causing unrestrained gastrin release from the gastrin-producing antral G-cells. Both entities differ with respect to the pH in the gastric fluid, which is < 2 in patients with Zollinger-Ellison syndrome and neutral in type A gastritis. Other conditions with moderate hypergastrinemia as treatment with proton pump inhibitors, gastric outlet obstruction, previous vagotomy, chronic renal failure or short bowel syndrome are of minor clinical importance.


Assuntos
Doenças Autoimunes/diagnóstico , Neoplasias Duodenais/diagnóstico , Gastrinoma/diagnóstico , Gastrinas/sangue , Gastrite Atrófica/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Gástricas/diagnóstico , Doenças Autoimunes/sangue , Doenças Autoimunes/patologia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/patologia , Diagnóstico Diferencial , Neoplasias Duodenais/sangue , Neoplasias Duodenais/patologia , Celulas Tipo Enterocromafim/patologia , Mucosa Gástrica/patologia , Gastrinoma/sangue , Gastrinoma/patologia , Gastrite Atrófica/sangue , Gastrite Atrófica/patologia , Humanos , Hiperplasia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/sangue , Neoplasias Gástricas/patologia , Síndrome de Zollinger-Ellison/sangue , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologia
14.
Wien Klin Wochenschr ; 119(19-20): 570-2, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985089

RESUMO

Gastric neuroendocrine tumours (NET) are rare. Clinically they are classified in tumours type 1 to 3. The histological classification is according to the WHO 2000 classification for endocrine tumours. NET type 1 occur in coincidence with chronic atrophic gastritis, as single or multiple small tumours. The prognosis of type 1 tumours is excellent, with no tumour related death reported during follow-up. NET type 2 are part of the MEN-1 syndrome. These tumours may be more aggressive and even develop metastasis. However, in most patients with MEN-1 the prognosis is due to other manifestations of the disease as duodenal or pancreatic neuroendocrine tumours. Gastric neuroendocrine tumours type 3 are sporadic tumours without relationship to other gastric pathology. They tend to occur earlier, without sex preference. These tumours may develop an aggressive course, with metastatic disease and an overall poor prognosis. Thus, aggressive surgical therapy is recommended.


Assuntos
Gastrinoma/diagnóstico , Gastrinas/sangue , Tumores Neuroendócrinos/diagnóstico , Neoplasias Gástricas/diagnóstico , Biópsia , Doença Crônica , Diagnóstico Diferencial , Neoplasias Duodenais/sangue , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/patologia , Neoplasias Duodenais/terapia , Celulas Tipo Enterocromafim/patologia , Mucosa Gástrica/patologia , Gastrinoma/sangue , Gastrinoma/patologia , Gastrinoma/terapia , Gastrite Atrófica/sangue , Gastrite Atrófica/diagnóstico , Gastrite Atrófica/patologia , Gastrite Atrófica/terapia , Humanos , Neoplasia Endócrina Múltipla Tipo 1/sangue , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Neoplasia Endócrina Múltipla Tipo 1/patologia , Neoplasia Endócrina Múltipla Tipo 1/terapia , Tumores Neuroendócrinos/sangue , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/terapia , Prognóstico , Neoplasias Gástricas/sangue , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia
15.
Wien Klin Wochenschr ; 119(19-20): 588-92, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17985093

RESUMO

Cross sectional imaging in the assessment of gastrinomas has three major applications: Tumor localization (sporadic gastrinoma, MEN I) in patients undergoing primary or secondary surgery. Staging of metastasized tumors, especially assessment of lymph nodes and liver metastases, possibly including a risk analysis prior to liver resection. Post-surgery follow-up and monitoring of bio- or chemotherapy. Detection of primary tumors is strongly correlated with their size. However, the sensitivity of surgical assessment of the mostly small tumors by experienced surgeons is much higher than that of any imaging modality. Of all imaging modalities, endoultrasonography (EUS) followed by Somatostatin receptor scintigraphy (SRS) is the most sensitive modality for the assessment of pancreatic tumors in asymptomatic patients suffering from a MEN-I syndrome. Scintigraphy has the highest sensitivity in tumors of symptomatic patients and in the assessment of metastases. CT and MRI are only second line diagnostic modalities. Their sensitivity is largely dependent on the selection of patients. As a potential application, 3D reconstruction of nearly isotropic CT data sets for the risk assessment prior to liver resection is currently developing. Due to the absent radiation exposure, MRI is increasingly utilized to monitor the response of metastases under systemic therapy, e.g. in clinical trials.


Assuntos
Neoplasias Duodenais/patologia , Gastrinoma/patologia , Gastrinas/sangue , Imageamento por Ressonância Magnética , Neoplasias Pancreáticas/patologia , Tomografia Computadorizada por Raios X , Angiografia , Ensaios Clínicos como Assunto , Neoplasias Duodenais/sangue , Neoplasias Duodenais/diagnóstico , Duodeno/patologia , Gastrinoma/sangue , Gastrinoma/diagnóstico , Gastrinoma/secundário , Humanos , Fígado/patologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Metástase Linfática/patologia , Neoplasia Endócrina Múltipla Tipo 1/sangue , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Neoplasia Endócrina Múltipla Tipo 1/patologia , Estadiamento de Neoplasias , Pâncreas/patologia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico , Ultrassonografia , Síndrome de Zollinger-Ellison/sangue , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologia
16.
Clin Chim Acta ; 446: 15-20, 2015 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-25861845

RESUMO

Patients with neuroendocrine tumors are found with increasing frequency. Accordingly, knowledge about relevant tumor markers and assays for diagnosis and control has become essential. Neuroendocrine tumors release one or more granin proteins. Of these, chromogranin A (CgA) has so far become the most widely used general marker. The CgA protein is, however, extensively cleaved and otherwise modified during the biosynthetic processing. In addition, the CgA-processing in individual tumors varies considerably. But only few CgA-assays have taken the processing into account and characterized the assays with respect to precise epitope-specificity. Consequently, we do not know which fragments most CgA-assays measure. It is therefore at present difficult to compare CgA-measurements from tumor patients. Some tumors, however, release - in addition to granins - also a specific hormone that causes a clinical syndrome. This review uses gastrinomas (gastrin-producing tumors) as a starting point for discussion of CgA versus peptide hormone as tumor marker. Data available so far indicate that well-defined assays for gastrin have significantly higher diagnostic sensitivity than CgA measurements in gastrinomas. But the review suggests that CgA-quantitation using processing-independent analysis (PIA) may provide an equally high diagnostic sensitivity and in addition offer a simple possibility for estimation of the tumor-burden.


Assuntos
Biomarcadores Tumorais/sangue , Cromogranina A/sangue , Gastrinoma/sangue , Neoplasias Pancreáticas/sangue , Animais , Biomarcadores Tumorais/genética , Cromogranina A/genética , Gastrinoma/genética , Humanos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética
17.
J Clin Endocrinol Metab ; 76(4): 1072-4, 1993 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8473384

RESUMO

We have detected islet amyloid polypeptide (IAPP)-like immunoreactivity (-LI) in human pancreas and in a range of endocrine tumors, including oat cell carcinoma of the lung and pancreatic tumours producing insulin, gastrin, glucagon, and vasoactive intestinal peptide. Gel permeation chromatography of the IAPP-LI revealed that, except in the carcinoid, more than 80% coeluted with synthetic human IAPP. The remaining immunoreactivity consisted of variable amounts of larger and smaller molecular forms. The concentration of IAPP-LI in the circulation of patients with diagnosed pancreatic endocrine tumors was not significantly elevated above normal fasting levels. IAPP is, therefore, produced by a range of endocrine tumors and may relate to the deposition of endocrine amyloid.


Assuntos
Amiloide/metabolismo , Neoplasias das Glândulas Endócrinas/metabolismo , Gastrinoma/metabolismo , Insulinoma/metabolismo , Pâncreas/metabolismo , Adulto , Idoso , Amiloide/sangue , Cromatografia em Gel , Neoplasias das Glândulas Endócrinas/sangue , Gastrinoma/sangue , Humanos , Insulinoma/sangue , Polipeptídeo Amiloide das Ilhotas Pancreáticas , Pessoa de Meia-Idade , Radioimunoensaio
18.
J Clin Endocrinol Metab ; 88(7): 3117-20, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12843152

RESUMO

Ghrelin is a novel gastrointestinal hormone involved in several metabolic functions. Although the expression of ghrelin has been demonstrated in most gastrointestinal carcinoids and pancreatic tumors, the circulating levels of this peptide have been marginally assessed in patients with these disorders. We measured plasma ghrelin levels in 16 patients with gastrointestinal carcinoid (10 with midgut and 6 with gastric carcinoid), 24 patients with pancreatic tumor (8 with gastrinoma, 2 with insulinoma, 2 with vipoma, 1 with glucagonoma, and 11 with nonfunctioning tumor), and 35 healthy controls. Plasma ghrelin levels recorded in patients with gastroenteropancreatic tumors were similar to controls (mean +/- SE, 182.7 +/- 66.5 pM in patients vs. 329 +/- 32 pM in controls, P = not significant), and no significant difference between gastrointestinal and pancreatic, functioning and nonfunctioning, and metastatic and nonmetastatic tumors was observed. One patient with metastatic nonfunctioning pancreatic tumor had circulating ghrelin levels of 12,000 pM that were slightly reduced during chemotherapy and interferon therapy. Immunohistochemistry performed on peritoneal lesions showed an intense, focal cytoplasmic positivity for ghrelin. Despite the 50-fold increase in ghrelin concentrations, the patient had normal serum GH and IGF-I levels. In conclusion, the study showed that carcinoids and pancreatic tumors rarely cause ghrelin hypersecretion. However, in this series, 1 pancreatic ghrelinoma not associated with clinical features of acromegaly was identified.


Assuntos
Carcinoma Neuroendócrino/sangue , Neoplasias Gastrointestinais/sangue , Neoplasias Pancreáticas/sangue , Hormônios Peptídicos/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Carcinoma Neuroendócrino/metabolismo , Feminino , Gastrinoma/sangue , Neoplasias Gastrointestinais/metabolismo , Grelina , Glucagonoma/sangue , Humanos , Insulinoma/sangue , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/metabolismo , Hormônios Peptídicos/metabolismo , Estudos Retrospectivos , Vipoma/sangue
19.
J Clin Endocrinol Metab ; 82(8): 2622-8, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9253344

RESUMO

Chromogranin A (CgA) is gaining acceptance as a serum marker of neuroendocrine tumors. Its specificity in differentiating between neuroendocrine and nonneuroendocrine tumors, its sensitivity to detect small tumors, and its clinical value, compared with other neuroendocrine markers, have not clearly been defined, however. The objectives of this study were to evaluate the clinical usefulness of CgA as neuroendocrine serum marker. Serum levels of CgA, neuron-specific enolase (NSE), and the alpha-subunit of glycoprotein hormones (alpha-SU) were determined in 211 patients with neuroendocrine tumors and 180 control subjects with nonendocrine tumors. The concentrations of CgA, NSE, and alpha-SU were elevated in 50%, 43%, and 24% of patients with neuroendocrine tumors, respectively. Serum CgA was most frequently increased in subjects with gastrinomas (100%), pheochromocytomas (89%), carcinoid tumors (80%), nonfunctioning tumors of the endocrine pancreas (69%), and medullary thyroid carcinomas (50%). The highest levels were observed in subjects with carcinoid tumors. NSE was most frequently elevated in patients with small cell lung carcinoma (74%), and alpha-SU was most frequently elevated in patients with carcinoid tumors (39%). Most subjects with elevated alpha-SU levels also had elevated CgA concentrations. A significant positive relationship was demonstrated between the tumor load and serum CgA levels (P < 0.01, by chi 2 test). Elevated concentrations of CgA, NSE, and alpha-SU were present in, respectively, 7%, 35%, and 15% of control subjects. Markedly elevated serum levels of CgA, exceeding 300 micrograms/L, were observed in only 2% of control patients (n = 3) compared to 40% of patients with neuroendocrine tumors (n = 76). We conclude that CgA is the best general neuroendocrine serum marker available. It has the highest specificity for the detection of neuroendocrine tumors compared to the other neuroendocrine markers, NSE and alpha-SU. Elevated levels are strongly correlated with tumor volume; therefore, small tumors may go undetected. Although its specificity cannot compete with that of the specific hormonal secretion products of most neuroendocrine tumors, it can have useful clinical applications in subjects with neuroendocrine tumors for whom either no marker is available or the marker is inconvenient for routine clinical use.


Assuntos
Biomarcadores Tumorais/sangue , Cromograninas/sangue , Subunidade alfa de Hormônios Glicoproteicos/sangue , Tumores Neuroendócrinos/sangue , Fosfopiruvato Hidratase/sangue , Adulto , Idoso , Tumor Carcinoide/sangue , Carcinoma Medular/sangue , Carcinoma de Células Pequenas/sangue , Cromogranina A , Diagnóstico Diferencial , Feminino , Gastrinoma/sangue , Humanos , Ácido Hidroxi-Indolacético/urina , Neoplasias Pulmonares/sangue , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Tumores Neuroendócrinos/diagnóstico , Neoplasias da Glândula Tireoide/sangue
20.
J Clin Endocrinol Metab ; 69(4): 902-5, 1989 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-2778040

RESUMO

We have determined the effects of Sandostatin (SMS 201-995, Sandoz) on chromogranin-A (CgA) in the blood of 14 patients with neuroendocrine tumors of the gastroenteropancreatic axis, 7 with carcinoid tumors, 5 with gastrinomas, and 1 each with a glucagonoma and tumor-secreting vasoactive intestinal peptide. Two thirds of the patients had elevated plasma CgA. Sandostatin administration suppressed CgA in 12 of the 14 patients. In 8 of 10, the clinical response to Sandostatin paralleled the reduction in CgA levels. There was a strong correlation between the change in CgA levels and the respective blood concentration of the hormone produced by the tumor. Serial measurement of CgA may provide an additional means of monitoring these tumors and their secretory activity where other measures are not available.


Assuntos
Tumor Carcinoide/sangue , Cromograninas/sangue , Neoplasias Duodenais/sangue , Gastrinoma/sangue , Neoplasias do Íleo/sangue , Neoplasias Hepáticas/secundário , Proteínas do Tecido Nervoso/sangue , Octreotida/uso terapêutico , Neoplasias Pancreáticas/sangue , Adulto , Idoso , Tumor Carcinoide/tratamento farmacológico , Cromogranina A , Neoplasias Duodenais/tratamento farmacológico , Feminino , Gastrinoma/tratamento farmacológico , Glucagonoma/sangue , Glucagonoma/tratamento farmacológico , Humanos , Neoplasias do Íleo/tratamento farmacológico , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA