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

T.M.A. Kerkhofs, M.N. Kerstens, I.P. Kema, T.P. Willems, H.R. Haak

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)

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 mu mol/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.

Original languageEnglish
Pages (from-to)168-175
Number of pages8
JournalHormones and Cancer
Volume6
Issue number4
DOIs
Publication statusPublished - Aug 2015

Keywords

  • ADRENOCORTICAL CARCINOMA
  • FOLLOW-UP
  • INCIDENTALOMA
  • MASS
  • STEROIDOGENESIS
  • MANAGEMENT
  • FEATURES
  • ENZYMES
  • CANCER
  • RISK

Cite this

Kerkhofs, T.M.A. ; Kerstens, M.N. ; Kema, I.P. ; Willems, T.P. ; Haak, H.R. / Diagnostic Value of Urinary Steroid Profiling in the Evaluation of Adrenal Tumors. In: Hormones and Cancer. 2015 ; Vol. 6, No. 4. pp. 168-175.
@article{12070acfdfb5490da67796d6d23e0c91,
title = "Diagnostic Value of Urinary Steroid Profiling in the Evaluation of Adrenal Tumors",
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 mu mol/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.",
keywords = "ADRENOCORTICAL CARCINOMA, FOLLOW-UP, INCIDENTALOMA, MASS, STEROIDOGENESIS, MANAGEMENT, FEATURES, ENZYMES, CANCER, RISK",
author = "T.M.A. Kerkhofs and M.N. Kerstens and I.P. Kema and T.P. Willems and H.R. Haak",
year = "2015",
month = "8",
doi = "10.1007/s12672-015-0224-3",
language = "English",
volume = "6",
pages = "168--175",
journal = "Hormones and Cancer",
issn = "1868-8497",
publisher = "Springer",
number = "4",

}

Diagnostic Value of Urinary Steroid Profiling in the Evaluation of Adrenal Tumors. / Kerkhofs, T.M.A.; Kerstens, M.N.; Kema, I.P.; Willems, T.P.; Haak, H.R.

In: Hormones and Cancer, Vol. 6, No. 4, 08.2015, p. 168-175.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Diagnostic Value of Urinary Steroid Profiling in the Evaluation of Adrenal Tumors

AU - Kerkhofs, T.M.A.

AU - Kerstens, M.N.

AU - Kema, I.P.

AU - Willems, T.P.

AU - Haak, H.R.

PY - 2015/8

Y1 - 2015/8

N2 - 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 mu mol/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.

AB - 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 mu mol/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.

KW - ADRENOCORTICAL CARCINOMA

KW - FOLLOW-UP

KW - INCIDENTALOMA

KW - MASS

KW - STEROIDOGENESIS

KW - MANAGEMENT

KW - FEATURES

KW - ENZYMES

KW - CANCER

KW - RISK

U2 - 10.1007/s12672-015-0224-3

DO - 10.1007/s12672-015-0224-3

M3 - Article

VL - 6

SP - 168

EP - 175

JO - Hormones and Cancer

JF - Hormones and Cancer

SN - 1868-8497

IS - 4

ER -