Adrenocorticalcarcinoma (ACC) is amalignant tumor, whichcan occurat any age. The prevalence ofACCin populationis0.5-2cases per1,000,000people per year; the incidence ofACCin patients withadrenal incidentalomasis1.2-12%. By the revealingadrenal tumor, it is necessary to identify whether this adrenal mass is malignant or/andhormonally active. In spite of using such visualdiagnostic methodsasultrasound, CT, MRI, PET, it’s not always possibleto detect malignancy ofadrenal massin dailyclinical practice.
Some experts suppose that urinary steroid profiling(USP) is the most significantfor the diagnosisof adrenalcarcinoma. The researchersnote an increase ofadrenalsteroidogenesisprecursors in 85% of patients with ACCby gaschromatography-mass-spectrometry (GC-MS) and consider it ismore sensitive and specificfordifferential diagnosisbetween benign and malignantadrenocorticaltumors.
In our studywe determined steroid profiling in combination ofHPLC andGC-MS data. Urinary steroid profiling (USP) were studied by methods of high-performance liquidchromatography (HPLC) and gaschromatography-mass-spectrometry (GC-MS) in 139patients withadrenocorticaladenoma(ACA) and31 patientswithadrenocorticalcancer(ACC). The main features ofACCwere increased levels of the following urinary steroid metabolities:tetrahydro-11-deoxycortisol (THS), dehydroepiandrosterone(DHEA)and its metabolites, etiocholanolone, 16-oxo-androstendiol, pregnanediol, pregnanetriol(P3), 11-oxo-P3, 6β-OH-pregnanolone, pregnenediol(dP2), 3α,17,20-pregnenetriol (3αdP3), 3βdP3,3α,16,20dP3, 3β,16,20dP3, 16-OH-pregnenolone (16dP), 21dP, 21dP2and11dP3, also 11β-hydroxylase and/or 21-hydroxylase deficiency. However, DHEA was increased in 67.7% of patients with ACC and THS - in 74.2%. The highest sensitivity and specificity for the differential diagnosis of ACC and ACA were achieved by combination of following parameters: THS> 900 µg/24 hr and/or DHEA> 1500 µg/24 hr with relations of 3α,16,20dP3 / 3β,16,20dP3 less than 6.0 and 3αdP3 / 3βdP3 less than 9.0, and the detection of at least 2 of 5-en-pregnens not revealed in patients with ACA.
Our findings show the importance of usingGC-MSand HPLC for differential diagnostics ofACCandACA, which in combination with imagingcould improve the accuracy of diagnosing ACC before surgury.
The further studies are needed for finding the most informative biochemical markers of ACC.