Plasma Steroid Profiling in Patients With Adrenal Incidentaloma.

Abstract

CONTEXT:

Most patients with adrenal incidentaloma have nonfunctional lesions that do not require treatment, while others have functional or malignant tumors that require intervention. The plasma steroid metabolome may be useful to assess therapeutic need.

OBJECTIVE:

This work aimed to establish the utility of plasma steroid profiling combined with metanephrines and adrenal tumor size for the differential diagnosis of patients with adrenal incidentaloma.

METHODS:

This retrospective cross-sectional study, which took place at 7 European tertiary-care centers, comprised 577 patients with adrenal incidentaloma, including 19, 77, 65, 104 and 312 respective patients with adrenocortical carcinoma (ACC), pheochromocytoma (PHEO), primary aldosteronism (PA), autonomous cortisol secretion (ACS), and nonfunctional adrenal incidentaloma (NFAI). Mesaures of diagnostic performance were assessed (with [95% CIs]) for discriminating different subgroups of patients with adrenal incidentaloma.

RESULTS:

Patients with ACC were characterized by elevated plasma concentrations of 11-deoxycortisol, 11-deoxycorticosterone, 17-hydroxyprogesterone, androstenedione, and dehydroepiandrosterone-sulfate, whereas patients with PA had elevations of aldosterone, 18-oxocortisol, and 18-hydroxycortisol. A selection of those 8 steroids, combined with 3 others (cortisol, corticosterone, and dehydroepiandrosterone) and plasma metanephrines, proved optimal for identifying patients with ACC, PA, and PHEO at respective sensitivities of 83.3% (66.1%-100%), 90.8% (83.7%-97.8%), and 94.8% (89.8%-99.8%); and specificities of 98.0% (96.9%-99.2%), 92.0% (89.6%-94.3%), and 98.6% (97.6%-99.6%). With the addition of tumor size, discrimination improved further, particularly for ACC (100% [100%-100%] sensitivity, 99.5% [98.9%-100%] specificity). In contrast, discrimination of ACS and NFAI remained suboptimal (70%-71% sensitivity, 89%-90% specificity).

CONCLUSION:

Among patients with adrenal incidentaloma, the combination of plasma steroid metabolomics with routinely available plasma free metanephrines and data from imaging studies may facilitate the identification of almost all clinically relevant adrenal tumors.

• Authors: Kristina Berke, Georgiana Constantinescu, Jimmy Masjkur, Otilia Kimpel, Ulrich Dischinger, Mirko Peitzsch, Aleksandra Kwapiszewska, Piotr Dobrowolski, Svenja Nölting, Martin Reincke, Felix Beuschlein, Stefan R Bornstein, Aleksander Prejbisz, Jacques W M Lenders, Martin Fassnacht, Graeme Eisenhofer
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 107 Issue 3 Pg. e1181-e1192 (02 17 2022) ISSN: 1945-7197 [Electronic] United States
• PMID: 34665854 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Steroids
• Metanephrine

Topics

• Adrenal Gland Neoplasms (blood, diagnosis, pathology)
• Adrenal Glands (diagnostic imaging, pathology)
• Adrenocortical Carcinoma (blood, diagnosis)
• Adult
• Aged
• Cross-Sectional Studies
• Diagnosis, Differential
• Female
• Humans
• Hyperaldosteronism (blood, diagnosis)
• Male
• Metanephrine (blood)
• Middle Aged
• Pheochromocytoma (blood, diagnosis)
• Retrospective Studies
• Steroids (blood)
• Tumor Burden