Raised chromogranin-A

I have a history of what seems to be pancreatic/bilary pain, boring through the epigastric area and radiating to the back since 2003. Has been thought to be pancreatitis but never showed up in the tests. Have had some liver function test abnormalities but these vary between slightly raised and normal. Have a small liver cyst on ultrasound. Symptoms infrequent at first, now increasing in frequency and accompanied by additional symptoms (a general tendency for increased blood sugars, accompanied by sudden lows and very fast drops), intermittent spikes in bp and sinus tachycardia, intermittent diaorrhea. Last scans (MRI) in 2006 were clear. Chromogranin-A now come back at 199.

Significant history is cholecystectomy (no stones), coeliac disease diagnosed by gene testing because on steroid therapy, history of ulcers while on omeprazole (currently taking 80mg) day and last endoscopy was clear, small sliding hiatus hernia, past investigation for pheo (2003), MIBG revealed two minor spots which were considered not important.

The plan now is for an endoscopy and then an octreotide scan. I have concerns about the endoscopy because, while I have had many, I did have airway collapse in one (although I've had these procedures since), I am steroid dependent and I am having such odd symptoms.

I'm wondering if there are other steps that should be done ahead of these procedures? Are there other questions I need to ask? Note I was taking omeprazole when tested for chromogranin-A.

Any advice appreciated.

[Kevin Pho, MD]

I agree with the diagnostic course thus far, and indeed, upper digestive issues and conditions can lead to some of the symptoms you are describing.

An upper endoscopy is a reasonable option to evaluate for these issues.  If there are other diseases present that may complicated the procedure, a formal anesthesia pre-operative consult should be considered to see if there should be any precautions needed prior to the exam.

Also, with the possible biliary pain, an MRCP can be done to image the biliary ducts for possible blockages.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[Kevin Pho, MD]

Regarding the chromogranin-A, I agree with the octreotide scan, and I am not aware omeprazole interfereing with the results.

Obtaining urine tests for 5-HIAA can also be considered to screen for carcinoid.

Thanks,
Kevin

[wurstsemmel]

Many thanks for your answers. I just wanted a second opinion on the proposed testing.
Best wishes,
WS