Adu-Gyamfi Kwabena Oware, Gyamfi Richmond, Patri Sandeep
Department of Hospitalist Medicine, HSHS St. Mary's Hospital Medical Center, Green Bay, WI, USA.
Endocrinology Department, Prevea Health, Green Bay, WI, USA.
J Community Hosp Intern Med Perspect. 2019 Dec 14;9(6):511-514. doi: 10.1080/20009666.2019.1682748. eCollection 2019.
: To describe an unusual case of symptomatic hyperchromograninemia associated with proton pump inhibitor (PPI) use. : A 55-year-old man with stage 1 follicular lymphoma and GERD on omeprazole presented with symptoms suggesting carcinoid syndrome. The only positive finding on workup was a markedly elevated level of chromogranin A and no carcinoid tumor was identified. Omeprazole was discontinued, following which his symptoms resolved and chromogranin A levels returned to normal. To the best of our knowledge, no symptoms have been previously reported in association with PPI-induced hyperchromograninemia. : The reliability of chromogranin A as a marker for neuroendocrine tumors is of growing concern. The reasons for the associated symptomatology in this case are unclear but could involve physiologic effects of chromogranin A breakdown products. The role of pharmacogenomics in PPI metabolism is discussed as a potential explanation for the significant hyperchromograninemia. : The phenomenon of PPI-induced hyperchromograninemia is highlighted for providers especially in the context of neuroendocrine tumor diagnosis and surveillance. The need for more research into chromogranins is proposed.
描述一例与质子泵抑制剂（PPI）使用相关的症状性高嗜铬粒蛋白血症的罕见病例。一名55岁患有1期滤泡性淋巴瘤且因胃食管反流病服用奥美拉唑的男性，出现提示类癌综合征的症状。检查中唯一的阳性发现是嗜铬粒蛋白A水平显著升高，未发现类癌肿瘤。停用奥美拉唑后，他的症状消失，嗜铬粒蛋白A水平恢复正常。据我们所知，此前尚无与PPI诱导的高嗜铬粒蛋白血症相关症状的报道。嗜铬粒蛋白A作为神经内分泌肿瘤标志物的可靠性日益受到关注。该病例中相关症状的原因尚不清楚，但可能涉及嗜铬粒蛋白A分解产物的生理效应。讨论了药物基因组学在PPI代谢中的作用，作为显著高嗜铬粒蛋白血症的潜在解释。尤其在神经内分泌肿瘤诊断和监测的背景下，向医疗服务提供者强调了PPI诱导的高嗜铬粒蛋白血症现象。提出需要对嗜铬粒蛋白进行更多研究。
