Site | Type | Laboratory tests required | Results expected |
Gastric | I and II | CgA, gastrin | Raised |
III | CgA, gastrin | Raised CgA, gastrin not raised | |
Duodenal | CgA, gastrin, PP, urinary 5-HIAA, SOM | Raised CgA in 90% | |
Consider MEN1 | |||
Jejunal, ileal and proximal colon | CgA, urinary 5-HIAA, NKA | Raised CgA (>80%), U-5-HIAA (70%) and/or NKA (>80%); see text | |
Proximal colon | CgA, urinary 5-HIAA, NKA, (PP) | Raised CgA (>80%), U-5-HIAA (70%) and/or NKA (>80%); see text | |
Appendiceal | CgA, urinary 5-HIAA, NKA, (PP) | None raised unless metastatic | |
Metastatic: markers as ileal | |||
Goblet cell | CgA, urinary 5-HIAA, NKA, (PP) | None raised | |
Rectal | CgA, CgB, PP, glucagon, HCG-β | Raised CgA (rarely); see text | |
Raised CgB, PP, glucagon and/or HCG-β in some | |||
Pancreatic | CgA | Raised CgA in metastatic tumours only | |
Insulinoma | CgA, insulin, blood glucose, | Insulin inappropriate to glucose; see text | |
C peptide or pro-insulin | Raised C peptide and pro-insulin | ||
Gastrinoma | Gastrin | Raised gastrin; see text | |
Glucagonoma | Glucagon, enteroglucagon | Raised glucagon | |
VIPoma | VIP | Raised VIP | |
Somatostatinoma | SOM | Raised SOM | |
PPoma | PP | Raised PP | |
MEN1 | CgA, gastrin, (calcium, PTH), insulin, glucagon, PP |
Items in parentheses may be helpful for diagnosis and monitoring in individual patients.
CgA, chromogranin A; CgB, chromogranin B; HGC-β, human chorionic gonadotrophin β; 5-HIAA, 5 hydroxyindoleacetic acid; NKA, neurokinin A; PP, pancreatic polypeptide; PTH, parathyroid hormone; SOM, somatostatin; VIPoma, vasoactive intestinal peptide-secreting tumour.