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Evaluation of NH₂-Terminus Gastrins in Gastrinoma Syndrome^*

Departments of Internal Medicine and Surgery (Division of Endocrinology and Metabolism), University of Michigan, Ann Arbor, Michigan 48109; Ohio State University, Columbus, Ohio 43210; Immuno Nuclear, Stillwater, Minnesota 55082

Address all correspondence and requests for reprints to: Aaron I. Vinik, M.D., University of Michigan Medical Center, 1405 East Ann Street, Room D2226 Medical Professional Building, Box 046, Ann Arbor Michigan 48109.

Forty-six patients with the gastrinoma syndrome were divided into 2 categories: 1) benign sporadic gastrinoma (n = 30), and 2) gastrinoma with metastases to liver (n = 16). Thirteen of the 46 patients had multiple endocrine neoplasia type I syndrome. Serum gastrin levels in patients fasted overnight were determined by RIA using antisera directed toward the NH₂- and COOH-terminals of heptadecapeptide gastrin (G17) and the NH2-terminus of the triacontatetrapeptide (G34). These results were compared with findings in 50 normal subjects. In the normal subjects, the mean COOH-terminal gastrin-17 level was higher [65 ± 8 (±SEM) pg/ml] than the NH₂-terminal gastrin-17 level (11 ± 0.2 pg/ml) and lower than the Nonterminal gastrin-34 level (134 ± 20 pg/ml). The levels of NH₂- terminal gastrin-17 were higher in patients with metastatic disease than in those with benign gastrinoma, whereas the COOH-terminal gastrin-17 and the NH₂-terminal gastrin-34 levels were similarly high in both groups. The mean ratio of NH₂-terminal gastrin-17 to COOH-terminal gastrin-17 was less than 1 in normal subjects (0.22 ± 0.02) and benign gastrinoma patients (0.2 ± 0.04), and it was 2.2 ± 0.41 in the patients with metastatic gastrinoma. An NH₂ to COOH gastrin-17 ratio greater than 1 was found in 13 of 16 patients with metastatic gastrinoma, but in none of the patients with benign gastrinoma or normal subjects. Similar results were found in multiple endocrine neoplasia type I patients with benign and metastatic disease. A high NH₂ to COOH gastrin-17 ratio is suggestive of metastatic gastrinoma. In 4 patients with metastatic gastrinoma, the NH₂ to COOH gastrin-17 ratio fell in parallel with the response to chemotherapy.

^* This work was supported by NIH grants to the Clinical Research Centers at the University of Michigan (5M01–RR-00042–22)and the Ohio State University Hospital (RR-00034–23)

Received July 19, 1985.

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