Urinary steroid profiling differentiates adrenocortical adenoma from carcinoma

At King’s, increasing referrals of adult patients with endocrine neoplasms – effective team approach
Heeded call at 2011 BES meeting to share findings. Here we compare findings on ACC v. ACA in King’s patients
Methods:
- Urinary steroid profiling (USP) by GC up to 2005 and by GC-MS (with cyclic scanning) thereafter. Values for 19 steroids in standard report but significant additional steroids added as appropriate
- Interpretation of tumour steroidogenic activity is based on relative increase of both common and unusual steroids
- All data accessible, so newly noted steroid markers can be looked for retrospectively in both GC & MS records
Patients:
Patients selected on basis of referral for USP during investigation of an adrenal mass
- ACC n=23: 22 with histology, 1 without – palliative care; 12 with no metastases at presentation; 3 with signs of androgen excess, 7 with signs of Cushing’s
- ACA n=15: 9 with histology, 6 without – no surgery; 2 with signs of androgen excess,10 with signs of Cushing’s
Summary:
- USP reliably differentiates ACC from ACA
- Steroid markers on USP display great variety – beneficial to examine profile in detail & identify the best markers for follow up of each patient
- No detectable correlations of USP with tumour size or presence of metastases
- Monitoring of markers continues to be informative during hydrocortisone and mitotane treatment