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False-positive secretin-KABI provocation test associated with achlorhydria
L J Hixson1, T R Morgan, R E Sampliner
1University of Arizona Health Sciences Center, Tucson.
Journal of Clinical Gastroenterology
|April 1, 1988
Summary
Secretin stimulation tests may yield false-positive results in patients with achlorhydria, potentially mimicking gastrinoma. Gastric analysis is recommended before secretin provocation testing to ensure accurate diagnosis.
Area of Science:
- Gastroenterology
- Endocrinology
- Diagnostic Testing
Background:
- Fasting hypergastrinemia and elevated serum gastrin after secretin stimulation can suggest gastrinoma.
- Secretin stimulation testing is a common diagnostic tool for gastrinoma.
Observation:
- Two patients with chronic abdominal pain and hypergastrinemia showed significant serum gastrin increases after Secretin-KABI injection.
- Both patients were later found to have pentagastrin-fast achlorhydria.
- Gastric acid instillation suppressed serum gastrin levels by over 60%.
Findings:
- Achlorhydria can lead to false-positive elevations in serum gastrin (>200 pg/ml) following Secretin-KABI injection.
- Pancreatic imaging (ultrasound, CT) and laparotomy were normal in these cases.
Implications:
- Gastric analysis for hypochlorhydria should precede secretin provocation testing to avoid misdiagnosis.
- Accurate diagnosis is crucial for appropriate management of gastrointestinal symptoms and hormonal imbalances.