Skip to main content
SpringerLink
Log in

Criteria for the glucagon provocative test in the diagnosis of gastrinoma

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Murugesan SVM, Varro A, Pritchard DM. Strategies to determine whether hypergastrinemia is due to Zollinger-Ellison syndrome rather than a more common benign cause. Aliment Pharmacol Ther. 2009;29:1055–68.

    Article  PubMed  CAS  Google Scholar 

  2. Isenberg JI, Walsh JH, Passaro E Jr, Moore EW, Grossman MI. Unusual effect of secretin on plasma gastrin and gastric acid secretion in a patient with suspected Zollinger-Ellison syndrome. Gastroenterology. 1972;62:626–31.

    PubMed  CAS  Google Scholar 

  3. Deveney CW, Deveney KS, Jaffe BM, Jones RS, Way LW. Use of calcium and secretin in the diagnosis of gastrinoma (Zollinger-Ellison syndrome). Ann Intern Med. 1977;87:680–6.

    Article  PubMed  CAS  Google Scholar 

  4. Lamers CB. Clinical usefulness of the secretin provocation test. J Clin Gastroenterol. 1981;3:255–9.

    Article  PubMed  CAS  Google Scholar 

  5. Turner JJO, Wren AM, Jackson JE, Thakker RV, Meeran K. Localization of gastrinomas by selective intra-arterial calcium injection. Clin Endocrinol. 2002;57:821–5.

    Article  CAS  Google Scholar 

  6. Wada M, Komoto I, Doi R, Imamura M. Intravenous calcium injection test is a novel complementary procedure in differential diagnosis for gastrinoma. World J Surg. 2002;26:1291–6.

    Article  PubMed  Google Scholar 

  7. Shibata C, Funayama Y, Fukushima K, Ueno T, Kohyama A, Satoh K, et al. The glucagon provocative test for the diagnosis and treatment of Zollinger-Ellison syndrome. J Gastrointest Surg. 2008;12:344–9.

    Article  PubMed  Google Scholar 

  8. Korman MG, Soveny C, Hansky J. Effect of glucagon on plasma gastrin. II: studies in pernicious anemia and the Zollinger-Ellison syndrome. Gut. 1973;14:459–61.

    Article  PubMed  CAS  Google Scholar 

  9. Frucht H, Howard JM, Slaff JI, Wank SA, McCarthy DM, Maton PN, et al. Secretin and calcium provocative tests in Zollinger-Ellison syndrome. Ann Intern Med. 1989;111:713–22.

    Article  PubMed  CAS  Google Scholar 

  10. Berna MJ, Hoffmann KM, Long SH, Serano J, Gibril F, Jensen RT. Plasma gastrin in Zollinger-Ellison syndrome: II. Prospective study on gastrin provocative testing in 293 patients from the National Institute of Health and comparison with 537 cases from the literature. Evaluation of diagnostic criteria, proposal of new criteria, and correlation with clinical and tumoral features. Medicine (Baltimore). 2006;85:331–64.

    Article  CAS  Google Scholar 

  11. Thompson JC, Reeder DD, Villar HV, Fender HR. Natural history and experience with diagnosis and treatment of the Zollinger-Ellison syndrome. Surg Gynecol Obstet. 1975;140:721–39.

    PubMed  CAS  Google Scholar 

  12. Imamura M, Komoto I, Ota S. Changing treatment strategy for gastrinoma in patients with Zollinger-Ellison syndrome. World J Surg. 2006;30:1–11.

    Article  PubMed  Google Scholar 

  13. Roy PK, Venzon DJ, Shojamanesh H, Abou-Saif A, Peghini P, Doppman JL, et al. Zollinger-Ellison syndrome. Clinical presentation in 261 patients. Medicine (Baltimore). 2000;79:379–411.

    Article  CAS  Google Scholar 

  14. Shibata C, Funayama Y, Fukushima K, Takahashi K, Ueno T, Nagao M, et al. Role of selective arterial secretin injection test in treatment of gastrinoma. Hepatogastroenterology. 2006;52:960–3.

    Google Scholar 

  15. Hansky J, Soveny C, Korman MG. The effect of glucagon on plasma gastrin. I: studies in normal subjects. Gut. 1973;14:457–61.

    Article  PubMed  CAS  Google Scholar 

  16. Long SH, Berna MJ, Thill M, Pace A, Pradhan TK, Hoffmann KM, et al. Secretin-receptor and secretin-receptor-variant expression in gastrinomas: correlation with clinical and tumoral features and secretin and calcium provocative test results. J Clin Endocrinol Metab. 2007;92:4394–402.

    Article  PubMed  CAS  Google Scholar 

  17. Tang C, Biemond I, Lamers CB. Expression of peptide receptors in human endocrine tumours of the pancreas. Gut. 1997;40:267–71.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Michael G. Sarr, Department of Surgery, Mayo Clinic, MN, USA, for reviewing this manuscript.

Author information

Authors and Affiliations

  1. Division of Biological Regulation and Oncology, Department of Surgery, Tohoku University School of Medicine, 1-1 Seriyo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Chikashi Shibata, Masayuki Kakyo, Makoto Kinouchi, Naoki Tanaka, Koh Miura, Takeshi Naitoh, Hitoshi Ogawa, Fuyuhiko Motoi, Shinichi Egawa & Michiaki Unno

  2. Department of Surgery, South Miyagi Medical Center, Ogawara, Miyagi, Japan

    Tatsuya Ueno & Hiroo Naito

Authors
  1. Chikashi Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masayuki Kakyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Makoto Kinouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koh Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takeshi Naitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hitoshi Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fuyuhiko Motoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shinichi Egawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tatsuya Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroo Naito
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Michiaki Unno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chikashi Shibata.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shibata, C., Kakyo, M., Kinouchi, M. et al. Criteria for the glucagon provocative test in the diagnosis of gastrinoma. Surg Today 43, 1281–1285 (2013). https://doi.org/10.1007/s00595-012-0334-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0334-2

Keywords

Search

Navigation