Chromogranin-A Levels and Refractory Bronchospasm in Interstitial Lung Disease: A Preliminary Report on the Favourable Response to Octreotide
O. Elshafie *
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
B. Jayakrishnan
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
M. Al Busaidi
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
B. Al Riyami
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
S. Hussein
Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman.
N. Woodhouse
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
*Author to whom correspondence should be addressed.
Abstract
Aims: A wide variety of lung pathologies are associated with pulmonary neuroendocrine cell hyperplasia (PNECH).
Presentation of Case: We report two patients with interstitial lung disease (ILD), severe persistent bronchospasm not responding to conventional therapy, and raised chromogranin-A (Cg-A) levels. A neuroendocrine tumour (NET) was suspected and both were given a therapeutic trial of octreotide. This led not only to a dramatic clinical improvement but also to the normalization of Cg-A levels. Cg-A levels were elevated in 6 additional patients with interstitial involvement but without bronchospasm. The raised Cg-A levels in these 8 patients and the response to octreotide in two who had bronchospasm supports a diagnosis of PNECH in ILD.
Conclusion: Cg-A levels should be measured in all patients with ILD. An octreotide trial should be considered in symptomatic patients with interstitial lung disease and elevated chromogranin levels.
Keywords: Chromogranin-A, interstitial lung disease, octreotide