Differential Diagnostics of Adrenocortical Incidentalomaswith Different Laboratory Technologies

Urinary steroid profiling (USP) was studied using high-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) methods in 108 patients with adrenocortical adenoma (ACA) and in 31 patients with adrenocortical carcinoma (ACC). Thirteen ACC and Cushing's syndrome (ACC-CS) patients had two types of USP as well as 18 ACC patients without hypercortisolism. These four types differed by androgen and glucocorticoid secretion of the adrenal cortex. Fifteen main ACC features were observed by GC-MS. Urinary excretion of dehydroepiandrosterone (DHEA) was increased in 67.7 % of ACC patients and tetrahydro-11-deoxycortisol (THS) in 74.2 %. By combination of the following parameters: THS >900 μg/24 h and/or DHEA >1500 μg/24 h with ratios of 3α,16,20-pregnentriol/3β,16,20-pregnentriol (3α,16,20dP3/3β,16,20dP3) less than 6.0 and 3α,17,20dP3/3β,17,20dP3 less than 9.0 and the detection of "non-classical" 5-en-pregnens, not found in ACA and healthy persons, 100 % sensitivity and specificity of ACC and ACA differential diagnosis were achieved. Features of 21-hydroxylase and 11β-hydroxylase deficiency were observed by GC-MS in 32.2 and 61.3 % of the ACC patients, respectively. Additional features for ACC-CS diagnostic were increased urinary excretion of 6β-hydroxycortisol, 18-hydroxycorticosterone, the sum (UFF + UFE) obtained by HPLC, tetrahydrocorticosterone, and the sum (THF + THE + allo-THF) obtained by GC-MS.

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Different Types of Urinary Steroid Profiling Obtained by High-Performance Liquid Chromatography and Gas Chromatography-Mass Spectrometry in Patients with Adrenocortical Carcinoma

Великанова

Shafigullina

Lisitsin

et al. 2016

HORM CANC

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Urinary steroid profiling by gas chromatography mass spectrometry: Early features of malignancy in patients with adrenal incidentalomas

et al. 2018

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Diagnostic algorithm of the subclinical forms of adrenal neoplasms

Blyumina

Григорьевна²,

Romashchenko

et al. 2021

Bulletin of the Russian Military Medical Academy

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The possibility of modifying the existing diagnostic algorithm of latent forms of hormone-active and potentially malignant formations in the adrenal glands using modern methods of laboratory diagnostics and radiation imaging is substantiated. In the clinic of a faculty of surgery and on its clinical base, experience in the examination and treatment of 1457 patients with various formations of the adrenal glands has been accumulated. Among them, 270 (14.9%) patients were selected, in whom precursor hormones of steroidogenesis and metabolites of catecholamines in the blood plasma were specially studied by high-performance liquid chromatography, tumor marker measurement, and three-phase computed tomography with intravenous contrast enhancement. Determination of steroidogenesis precursor hormones and catecholamine metabolites in the blood plasma by high-performance liquid chromatography in combination with traditional methods of laboratory diagnostics, use of computed tomography with intravenous contrast enhancement, construction of multiplanar reconstructions, and postprocessor image processing are the basis of a modified algorithm for verification of latent forms of hormone-active and potentially malignant tumors of the adrenal glands. The implementation of the diagnostic algorithm developed in the clinic made early diagnosis of the subclinical forms of NP neoplasms possible, as well as ensure the implementation of minimally invasive surgical interventions before the development of endocrine and metabolic disorders and consequently prevent the development of intraoperative and postoperative complications, which thereby reduce the duration of rehabilitation and disability of patients with good long-term treatment results and high quality of life.

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Differential Diagnostics of Adrenocortical Incidentalomaswith Different Laboratory Technologies

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Different Types of Urinary Steroid Profiling Obtained by High-Performance Liquid Chromatography and Gas Chromatography-Mass Spectrometry in Patients with Adrenocortical Carcinoma

Different Types of Urinary Steroid Profiling Obtained by High-Performance Liquid Chromatography and Gas Chromatography-Mass Spectrometry in Patients with Adrenocortical Carcinoma

Urinary steroid profiling by gas chromatography mass spectrometry: Early features of malignancy in patients with adrenal incidentalomas

Diagnostic algorithm of the subclinical forms of adrenal neoplasms

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