Endocrine Abstracts

Introduction: Gas chromatography/mass spectrometry based steroid profiling has been proposed as a tool for differentiating adrenocortical carcinoma (ACC) from benign adrenocortical adenoma (ACA). We retrospectively examined urinary steroid profiles from ten patients with ACC and 14 patients with ACA to determine, if the steroid profiles were predictive in distinguishing benign from malignant disease.

Methods: Patients who had undergone adrenalectomy for resection of adrenal mass in the Western Infirmary, Glasgow were identified from theatre list and records of multidisciplinary team meetings between 2006 and 2013. Patients with preoperative urinary steroid profiles measured by GC:MS were included. Clinical details and histopathology was confirmed from case records and duration of follow-up was recorded.

Results: ACAs were identified, (of which nine were non-functioning and five were cortisol secreting) while ten ACCs were identified. Of the ACAs two were males and eight were females while in the ACC group there were four males and five females. There were no statistically significant differences in the urinary steroid profile when analysed as continuous variables although in general, median values of most compounds (with the exception of cortisol metabolites and 11-oxo-pregnanetriol) were higher in ACC patients. When analysed as a binary outcome (normal vs above normal for any compound), using any abnormality of the urinary steroid profile had a sensitivity of 90% but a specificity of only 42%. If only the most informative compounds were included (pregnenetriol, THA, and THS), the sensitivity remained at 90% and specificity rose to 92%.

Conclusions: Urinary steroid profiles may provide additional information to other clinical parameters in the work up of adrenal lesions in differentiating benign from malignant disease. This may be a useful tool in the future in assisting management decisions regarding surgical intervention as opposed to conservative treatment of this difficult condition.