Endocrine Abstracts

Background: Serum liquid chromatography–tandem mass spectrometry (LC–MS/MS) steroid profiling is used for the diagnosis of adrenocortical carcinoma (ACC). Guidelines recommend endocrine work-up in addition to radiological imaging for follow-up in ACC, but data on this topic are scarce.

Aim: To retrospectively investigate an earlier detection of a recurrent or progressive disease by using endocrine follow-up with LC–MS/MS measurements in comparison to radiological imaging.

Methods: Patients were included in this retrospective study if pre-therapeutic hormone values, regular tumour evaluation by imaging, steroid measurements by LC–MS/MS, and details on therapies were available. The utility of steroid profiles in detecting recurrence or disease progression was assessed, whereby ‘endocrine progress’ was defined by elevation of at least 3 of 13 analysed hormones.

Results: Patients were divided in two cohorts. Cohort A included 47 patients after R0 resection, of whom 15 experienced recurrence and 32 did not. In cohort B, 52 patients with advanced disease (including 7 patients of cohort A with recurrence) could be evaluated on 74 visits when progressive disease was documented. In 20 of 89 cases with documented recurrence and disease progression, ‘endocrine progress’ was detectable prior radiological progress. In these cases, recurrence/progression was detected in median 32 days earlier by steroid measurement than by imaging, with 11-deoxycortisol and testosterone being the most sensitive markers. In 25/89 cases, no steroid hormones were elevated although a recurrence or a progressive disease was confirmed by radiologic imaging, whereas the remaining 44/89 cases did either have only 1–2 elevated steroids or the altered hormone pattern was only detected at the time, when the progress was also documented by imaging. In only 5/89 patients (5.6%) with recurrent or progressive disease an ‘endocrine progress’ (defined by at least 3 elevated steroids) was falsely diagnosed. Finally, patients with an early detection of a recurrence or a progression were compared to patients without reliable elevated steroid hormones. We saw a significant difference in the documented tumour mass in patients with or without an early detection (11.4 cm vs 7.4 cm; P=0.039). Mitotane could have an influence on steroid elevation since one third of patients without a clear steroid elevation had a mitotane plasma level above 14 mg/l, whereas this was only the case in 10% with an earlier ‘endocrine progress’ (P=0.034).

Conclusion: In conclusion, steroid profiling by LC–MS/MS is of value in detecting recurrent/progressive disease in ACC especially in patients with significant tumour volume.