Endocrine Abstracts

Background

The aim of the study was to evaluate urine steroid metabolomics by gas chromatography–mass spectrometry (GC–MS) for the adrenocortical carcinoma (ACC) metastases` biomarkers detection in patients after the surgery.

Patients and methods

33 postoperative ACC patients were examined before and after the surgery. The median age was 47 years (41–60). The Weiss score was more than 3 points according to the histological analysis. 9 patients were disease-free in the early postoperative period (up to 12 months after surgery). Metastases were detected 1–5 years after the operation in 18 patients. The control group consisted of 25 patients with adrenocortical adenoma (ACA) without malignant features defined by the histological analysis. The median age was 52 (47–61) years. We studied urine steroid profile using gas chromatograph–mass spectrometer SHIMADZU GCMS – QP 2020. Statistical data was processed with software STATISTICA for WINDOWS (Version 10). Results comparison was made using Mann–Whitney test.

Results

The ACC`s main biomarkers urinary excretion (dehydroepiandrosterone (DHEA), 16α-DHEA, etiocholanolone (Et), pregnandiol (P2), pregnantriol (P3), pregnendiol (dP2), 16-hydroxypregnendiol (16-OH-dP2), pregnentriol (dP3), tetrahydro-11-deoxycortisol (THS) was determined using GC–MS. The abovementioned metabolites excretion rates were decreased in all disease-free postoperative patients as compared to the same patients` preoperative steroid profiles. Nevertheless, the 16α- DHEA, 16-OH-dP2, THS excretion was increased compared with control group. The 21-hydroxypregnendiol (21-OH-dP2), 20-on-3, 11, 17 and 21-pregnentetrol (20-on -dP4) were identified in the urine of all ACC recurrence patients. The increased 16-OH-dP2-3β excretion and decreased 16-OH-dP2-3α/16-OH-dP2-3β ratio ( <2.0) were typical for ACC recurrence patients in comparison with disease-free patients. The 10 patients of the disease recurrence cohort had the THS, androgen (DHEA and its metabolites), progestogenes (P2, P3), 5-ene-pregnenes (dP2, dP3, 16-OH-dP2) increased excretion. While in the other 8 patients of the same cohort THS and 5-ene-pregnenes increase was observed.

Conclusion

ACC postoperative recurrence biomarkers were obtained using urinary steroid profiling. The study of androgen, progesterone, pregnenolone metabolites, THS, 3β, 16, 20-dP3, 21-OH-dP2, 21-OH-dP4 urinary excretion and 3α, 16, 20-dP3/3β, 16, 20-dP3 ratio is of particular importance for detecting the ACC metastases development in the early postoperative period.