Is Serum CgA Level Of 62 Ng/ml A Cause For Concern?

Posted on Thu, 18 May 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 18 May 2017 Answered on

Thu, 8 Jun 2017 Last reviewed on

Question : Chromogranin a testing for carcinoid. I had my boyfriend test for it. Results came back from Mayo today and his level was 62ng/ml. Their reference range is >92. So this looks good on there. But when I search normal range it says >39. This is concerning me. Can you tell me what the discrepancy is about?

Answered by Dr. Mirjeta Guni (38 minutes later)

Brief Answer:
it is within the normal ranges:

Detailed Answer:
Hello and thank you for asking!
I can understand your concern regarding to your boyfriend' s health.
The CgA tests that have been developed and validated by laboratories are all slightly different, and their results are not interchangeable.
When monitoring a patient over time, CgA tests should be performed by the same laboratory so that values can be compared.
So, it is within the normal ranges of Mayo's laboratory and should not be compared with other laboratories ranges.
Wish him good health.
Kind Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Mirjeta Guni (15 minutes later)

Are you an endocrinologist? I'm just curious because that is what I was searching for and will make me feel better. This is what I read from carcinoid foundation. "There is a normal level of Chromogranin A in the blood, and the range currently is less than 39ng/l.. Abnormal levels can vary form forty to the thousands. The sensitivity of the test for CgA is about". Does this not matter? Would it not concern you about your patients? Thank you for your reassurance. My partner is very upset with me for worrying. He is not concerned at all. Are you sure that this is not too high? One other specialist said that a lab that had a reference range in the 150 or so was too high so he disagreed with the lab. Thank you.

Answered by Dr. Mirjeta Guni (22 minutes later)

Brief Answer:
No need to get worried;

Detailed Answer:
Welcome back!
Yes, I am an endocrinologist.
Your concern is right because of the informations you read online.
In my laboratory we do have the same ranges (under 92). Furthermore, no one would doubt the normal ranges of Mayo clinic, the most well known endocrinological center in the world.
So, i reassure you, there is no reason to get worried.
Best wishes,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Mirjeta Guni (54 minutes later)

Ok. Another follow up. So this 62 is a very notmal reading? It doesnt concern you that the 39 is from the carcinoid foundation? So you feel that this information is not exactly correct? I wish they would have said depends on the lab. So you are positive that this is a normal result? Do you have people test in this range? He really doesnt have symptoms. He looks red sometimes and i worried he was flushing. But i have read that you would feel it? Thank you for your patience. I am getting treatment for my anxiety. He is getting a serotonin blood test too. The only thing i didnt have him do was the urine serotonin. But it sounds like if you had carcinoid syndrome from a foregut tumor the flushes would be even more obvious and intense?

Answered by Dr. Mirjeta Guni (20 minutes later)

Brief Answer:
about carcinoid syndrome;

Detailed Answer:
As I said before you can not compare the value of a certain test that has different ranges ( uses different kits) with that of another lab. that has other ranges.

If you have doubts, you may repeat chromogranin at another laboratory that has ranges under 39, for sure it should result under 39.

Regarding carcinoid syndrome, in most of the cases flushing is associated with diarrhea and if there are suspicions about it, 5-HIAA at 24 hours collected urine is very sensitive in making the diagnosis.

Of course, the physicians of Mayo Clinic will check it if it will be necessary.
I would suggest not to get worried and be patient for the time being.

You are in right hands. Let me know if I can assist you further.

Best wishes,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (25 minutes later)

Ok. So you are sure this is accurate and a safe result. I don't think it needs to be redone. As you said that is the reference range for your lab and you feel confident that this is a safe level?

I just want to make sure that this is not only something a carcinoid specialist will be aware of and that it will be missed

Answered by Dr. Mirjeta Guni (3 hours later)

Brief Answer:
About CGA:

Detailed Answer:
Hi again,

I would suggest waiting for the response of Mayo clinic, that will of course jump into a conclusion having into consideration the clinical symptoms, biochemical markers and other tests they may have done.

Carcinoid syndrome foundation assumes that CGA levels twice as normal levels are asymptomatic and not radiologically detectable. So, even if you compare it with their ranges he would not have symptoms with 62 ng/ml.

Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (24 minutes later)

Mayo clinic is just who the test is through. They are not evaluating him. I just want to make aure that this leas than 39 recommendationnis not just something that a carcinoid espert would be aware of and that as an endocrinologist you feel that i can reat rasy with the results. You would with your patients?

Answered by Dr. Mirjeta Guni (7 hours later)

Brief Answer:
See a physician in person:

Detailed Answer:
Hi again,
Of course he should see a physician in person who will evaluate his symptoms (how severe they are) and decide if he needs further tests (5 HIAA ect).
I just was trying to explain you that in my everyday practice i do not consider elevated a Chromogranine at that level, when the normal ranges are under 92.
Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Mirjeta Guni (1 hour later)

Ok. So you so treat patients with this level and consider it a normal chromogranin? I just want to make sure that it is not something only a carcinoid specialist would know? You are confident with the mayo test this is a safe a normal level. That is all i want to know?

Also, so you believe that the Mayo Clinic uses a reliable assay for this test? I was told by another person that it depends on the test and you have to be sure that it is reliable.

Answered by Dr. Mirjeta Guni (3 hours later)

Brief Answer:
Mayo clinic assay is one of the most reliable:

Detailed Answer:
Yes, of course Mayo clinic uses a reliable assay.
I would hardly suggest a center with a more reliable assay.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Mirjeta Guni (17 minutes later)

Ok. So you use assays with higher range and they are find. You feel confident I can rest assured?

Answered by Dr. Mirjeta Guni (3 hours later)

Brief Answer:
I feel confident about the result you reported;

Detailed Answer:
For almost all hormones exist assay with different normal ranges. We always judge the result basing on the ranges of the proper lab.
It is never suggested to compare with other ranges.
So, it is considered within the normal ranges.
In my practice, the chromogranin A levels, in carcinoid syndrome has been always very high, at least three times normal ranges. So I have been feeling confident with the ranges under 92.
Best wishes,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Mirjeta Guni (26 minutes later)

Ok. So this is not tricky to interpret at all and you are confiden? Thank you .

The ranges in your lab you mean you feel confident and it is not tricky.

Answered by Dr. Mirjeta Guni (1 hour later)

Brief Answer:
Interpretation of CGA level;

Detailed Answer:
Sorry to hear that, but there is no interest to be tricky in this question.
I have just try to interpret a chromogranin level reported by you.
If he were a patient in my clinic i would interpret it as normal.
Please see an endocrinologist in person if he has clinical symptoms that need to be diagnosed.

Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Raju A.T