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

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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