Serum Steroid Profiling For The Diagnosis Of Adrenocortical Carcinoma: A Prospective Cross-Sectional Study From A Tertiary Center

Document Type

Conference Proceeding

Publication Date

10-5-2024

Publication Title

Journal of the Endocrine Society

Keywords

cortodoxone, glucocorticoid, pregnenolone, progesterone, steroid, adrenal cancer, adrenal cortex adenoma, adrenal cortex carcinoma, adrenal tumor, adult, aged, biobank, cohort analysis, conference abstract, congenital adrenal hyperplasia, controlled study, cross-sectional study, diagnosis, early diagnosis, fasting, female, follow up, histopathology, human, liquid chromatography-mass spectrometry, major clinical study, male, quantization, steroid blood level, steroid urine level

Abstract

Context: Early diagnosis is essential to assure a better prognosis in patients with adrenocortical carcinoma (ACC). Guidelines suggested performing urine steroid profiling in patients with indeterminate adrenal tumors to make a noninvasive diagnosis of ACC. However, urine steroid profiling is notwidely available. Accuracy of clinically available serum steroids in diagnosing ACC has not been established. Objective: To determine the accuracy of 11-deoxycortisol, 17OH-progesterone, and 17OH-pregnenolone in diagnosing ACC. Design: Prospective single-center cohort study. Participants: Between 2015 and 2023, consecutive patients with adrenal mass were prospectively enrolled in the prospective registry and biobank study. Patients who agreed to contribute a fasting serumsamplewere included inthestudy. Exclusion criteria were congenital adrenal hyperplasia, exogenous glucocorticoid use, absence of unenhanced Hounsfield unitmeasurements (HU), and lack of established reference standard (histopathology, imaging characteristics, 2-year imaging follow up, or 5-year clinical follow up). Measures and Outcomes: measurements included 11-deoxycortisol, 17OH-progesterone, and 17OH-pregnenolone by liquid chromatography-mass spectrometry. Localized Generalized Matrix Learning Vector Quantization(LGMLVQ) analysiswasused todevelop serum steroid scoreand assessedwithareaunder receiver operating curve (AUROC). Results: Of 263 patients with adrenal masses, 44 (17%) were diagnosed with ACC, 161 (61%) with adrenocortical adenomas (ACAs), 27 (10%) with other adrenal malignancies, and 31 (12%) with other. HU ≥ 20 were demonstrated in allACCs, in all but one other adrenalmalignancy, and only in 58 (31%) ACAs. All 3 steroids were higher in patients with ACCs vs nonACCs, including when comparing ACCs with functioning ACAs, and with ACAs withHU ≥ 20 (P<0.0001 for all). LGMLVQ analysis yielded a serum steroid score that discriminated between ACC and non-ACC groups with a mean threshold fixed AUROC of 0.823. Serumsteroid score of 0.29 demonstrated amean false negative rate of 0% and a score of 0.61 demonstrated amean false positive rate of 0%. Conclusions: We showed that measurements of 11-deoxycortisol, 17OH-progesterone, and 17OH-pregnenolone could be valuable in diagnosing ACC. After appropriate validation, serumsteroid score could be integrated in clinical practice.

Volume

8

Issue

Suppl 1

First Page

A155

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