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Secretin and Calcium Provocative Tests in the Zollinger-Ellison Syndrome: A Prospective Study

Harold Frucht, MD; John M. Howard, MD; James I. Slaff, MD; Steven A. Wank, MD; Denis M. McCarthy, MD; Paul N. Maton, MD; Rakesh Vinayek, MD; Jerry D. Gardner, MD; and Robert T. Jensen, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Robert T. Jensen, MD, National Institutes of Health, Building 10, Room 9C-103, Bethesda, MD 20892.

Current Author Addresses: Drs. Frucht, Wank, Maton, Vinayek, Gardner, and Jensen: Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.

Dr. Howard: Victoria Hospital, 375 South St., London, Ontario N6A 4G5 Canada.

Dr. Slaff: 3428 N. Roosevelt Blvd., Key West, FL 33040.

Dr. McCarthy: VA Medical Center, 2100 Ridgecrest Dr. SE, Albuquerque, NM 87108.

Ann Intern Med. 1989;111(9):713-722. doi:10.7326/0003-4819-111-9-713
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Study Objective: To evaluate criteria of positivity for and usefulness of both the secretin and calcium gastrin-provocative tests in patients with the Zollinger-Ellison syndrome.

Design: Prospective trial in consecutive patients.

Setting: Referrals to a clinical research center.

Patients: Consecutive sample of 80 patients with the Zollinger-Ellison syndrome.

Intervention: Kabi-secretin (2 U/kg body weight) given by intravenous bolus and calcium gluconate (10%) (54 mg/kg · h [5 mg/kg · h of calcium]) given by continuous intravenous infusion for 3 hours. Serum gastrin measured at -15, and -1 minutes before, and 2, 5, 10, 15, 20, and 30 minutes after secretin, or every 30 minutes for 3 hours during the calcium infusion. Serum calcium and serum gastrin were measured simultaneously during the calcium infusion.

Measurements and Main Results: There was no significant difference in the responses of patients with different extents or locations of the tumor, presence or absence of multiple endocrine neoplasia, type-I, or with fasting gastrin less than or greater than 1000 pg/mL. In patients with fasting gastrin of less than 1000 pg/mL, the sensitivity of the secretin test using the criterion of an increase in gastrin of at least 110 pg/mL was 93% (CI, 76% to 99%) and for an increase of 200 pg/mL it was 85% (CI, 66% to 96%), (P > 0.05). With the calcium infusion test, the sensitivity using the criterion of an increase of 395 pg/mL was 43% (CI, 23% to 66%) and for an increase of 50% was 74% (CI, 52% to 90%), (P < 0.01). The calcium infusion test was positive in 33% of patients with a negative secretin test. With the secretin test, 75% of patients had a positive response by 5 minutes, 95% by 10 minutes, 100% by 15 minutes, and 6% only at 2 minutes. With calcium infusion, patients had positive responses at 120 to 180 minutes.

Conclusions: The secretin test is preferred over the calcium test because of its greater sensitivity and simplicity. The recommended criteria are a 200 pg/mL increase for the secretin test and a 395 pg/mL increase for the calcium test. The calcium test should be reserved for patients having a negative secretin test, gastric acid hypersecretion, and a strong clinical suspicion of the Zollinger-Ellison syndrome.





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