Diagnostic value of urinary steroid profiling in the evaluation of adrenal tumors
Open accessAbstract
Radiological examination may unexpectedly reveal an adrenal mass. Current algorithms for differentiating between benign and malignant lesions mainly rely on size and densitometry on unenhanced CT, which have limited specificity. We examined the diagnostic value of urinary steroid profiling by gas chromatography/mass-spectrometry (GC/MS) in differentiating between benign and malignant adrenal tumors. A retrospective study in two referral centers for patients with adrenal disease was performed. All urinary steroid profiles ordered for evaluation of an adrenal tumor between January 2000 and November 2011 were examined. Patients were diagnosed with adrenal cortical carcinoma (ACC), adrenal cortical adenoma (ACA), or other adrenal mass. Results of hormonal measurements, imaging studies, pathology reports, and clinical outcome were retrieved from medical records. The diagnostic value of individual urinary steroid metabolites was determined by receiver operating characteristics analysis. Cut-off values were compared to reference values from an age and gender-standardized population of healthy controls. Eighteen steroid metabolites were excreted in significantly higher concentrations in patients with ACC (n = 27) compared to patients with ACA (n = 107) or other adrenal conditions (n = 18). Tetrahydro-11-deoxycortisol (THS) at a cut-off value of 2.35 μmol/24 h differentiated ACC from other adrenal disorders with 100% sensitivity and 99% specificity. Elevated urinary excretion of THS was associated with a very high sensitivity and specificity to differentiate between an ACC and a benign adrenal mass. Urinary steroid profiling might be a useful diagnostic test for the evaluation of patients with an adrenal incidentaloma.
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All studies identified THS as the most informative steroid marker indicative of ACC.
“All studies identified THS as the most informative steroid marker indicative of ACC.”
From Adrenal incidentaloma (2020) · cites this paper as [348]
Kerkhofs et al. identified 15 individual steroid markers with sensitivity of 90% or above in detecting ACC, with THS again representing the most informative marker.
“They performed GC-MS analysis of 22 steroid metabolites and identified 15 individual steroid markers with a sensitivity of 90% or above in detecting ACC, with the 11-deoxycortisol metabolite (THS) again representing the most informative marker.”
From Adrenal incidentaloma (2020) · cites this paper as [348]
Cosecretion of a distinct combination of glucocorticoid and androgen metabolites is emerging as a sensitive diagnostic tool for ACC.
“In particular, the cosecretion of a distinct combination of glucocorticoid and androgen metabolites is emerging as a sensitive diagnostic tool for ACC (342,348,349).”
From Adrenal incidentaloma (2020) · cites this paper as [348]
Adrenocortical carcinomas present a unique steroidogenic "signature" characterized by accumulation of steroid hormone precursors.
“Additionally, recent retrospective studies employing GC-MS–based urine steroid profiling revealed that ACCs present a unique steroidogenic “signature” characterized by accumulation of steroid hormone precursors (1, 154, 155) (Fig. 8E).”
From Steroid Metabolome Analysis in Disorders of Adrenal Steroid Biosynthesis and Metabolism (2019) · cites this paper as [154]
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- Authors
- Kerkhofs, T. M. A., Kerstens, M. N., Kema, I. P., Willems, T. P., & Haak, H. R.
- Affiliations
- Máxima Medisch Centrum (NL)
- University Medical Center Groningen (NL)
- Maastricht University Medical Centre (NL)
- Corresponding author
- Kerkhofs, T. M. A.
- Venue
- Hormones and Cancer
- Published
- 2015-05-19
- Volume
- 6
- Issue
- 4
- Pages
- 168-175
- ISSN
- 1868-8497 (ISSN-L)
- 1868-8500
- PMC
- PMC4486399
- OpenAlex
- W1829257219
- Cited by
- 102
- References
- 26
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 9 · 2020: 16 · 2019: 12 · 2018: 10 · 2017: 7 · 2016: 7 · 2015: 6
- FWCI
- 10.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Hormones and Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- urinary steroid profiling, adrenal tumors, adrenocortical carcinoma, adrenal adenoma, adrenal incidentaloma, benign versus malignant differentiation, diagnostic accuracy, gas chromatography-mass spectrometry
- MeSH terms
- Adrenal Cortex Neoplasms, Adult, Aged, Carcinoma, Cortodoxone, Female, Humans, Male, Middle Aged, Prognosis, Steroids, Cohort Studies
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