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Cited by 105Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

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Diagnostic Value of Urinary Steroid Profiling in the Evaluation of Adrenal Tumors

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Kerkhofs, T. M. A., Kerstens, M. N., Kema, I. P., Willems, T. P., Haak, H. R.·2015·Hormones and Cancer
DOI 10.1007/s12672-015-0224-3PMC PMC4486399
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Abstract

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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Fig. 1 a–d. Median urinary excretion of 22 metabolites in patients with ACC, functioning adenoma, non-functioning adenoma, or other adrenal tumors organized per steroid class. A androsterone, E etiocholanolone, DHEA dehydroepiandrosterone, 11-KE 11-keto-etiocholanolone, 11-HA 11-hydroxy-androsterone, 11-HE 11-hydroxy-eticholanolone, THE tetrahydrocortisone, THF tetrahydrocortisol, allo-THF allo-tetrahydrocortisol, THA tetrahydro-11-dehydrocorticosterone, THB tetrahydrocorticosterone, allo-THB allo-tetrahydrocorticosterone, allo-P2 allo-pregnanediol, P2 pregnanediol, P3 pregnanetriol, Polone epi-pregnanolone, THS tetrahydro-11-deoxycortisol, PDL pregnanediolone, PTL pregnanetriolone. Whiskers indicate range, * indicates significant difference between ACC and other groups
Fig. 1 a–d. Median urinary excretion of 22 metabolites in patients with ACC, functioning adenoma, non-functioning adenoma, or other adrenal tumors organized per steroid class. A androsterone, E etiocholanolone, DHEA dehydroepiandrosterone, 11-KE 11-keto-etiocholanolone, 11-HA 11-hydroxy-androsterone, 11-HE 11-hydroxy-eticholanolone, THE tetrahydrocortisone, THF tetrahydrocortisol, allo-THF allo-tetrahydrocortisol, THA tetrahydro-11-dehydrocorticosterone, THB tetrahydrocorticosterone, allo-THB allo-tetrahydrocorticosterone, allo-P2 allo-pregnanediol, P2 pregnanediol, P3 pregnanetriol, Polone epi-pregnanolone, THS tetrahydro-11-deoxycortisol, PDL pregnanediolone, PTL pregnanetriolone. Whiskers indicate range, * indicates significant difference between ACC and other groupsCC BY · PubMed Central
Fig. 2 a–d. Receiver operating characteristic (ROC) curve for tetrahydro-11-deoxycortisol, pregnanediol, pregnanetriol, and etiocholanolone for the diagnosis of adrenocortical carcinoma
Fig. 2 a–d. Receiver operating characteristic (ROC) curve for tetrahydro-11-deoxycortisol, pregnanediol, pregnanetriol, and etiocholanolone for the diagnosis of adrenocortical carcinomaCC BY · PubMed Central
Fig. 3 a–d. Relationship between cut-off values, reference values, and measured urinary excretion of tetrahydro-11-deoxycortisol, pregnanediol, pregnanetriol, and etiocholanolone in 27 ACC patients
Fig. 3 a–d. Relationship between cut-off values, reference values, and measured urinary excretion of tetrahydro-11-deoxycortisol, pregnanediol, pregnanetriol, and etiocholanolone in 27 ACC patientsCC BY · PubMed Central

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Metadata

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.
ORCID
Venue
Hormones and Cancer
Publisher
Springer Science and Business Media LLC
Published
2015-05-19
Volume
6
Issue
4
Pages
168-175
ISSN
  • 1868-8497 (ISSN-L)
  • 1868-8500
DOI
10.1007/s12672-015-0224-3
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
Licence
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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