Endocrine Abstracts

Background: Several steroids have been reported as possible biomarkers for differentiation of adrenal adenomas from adrenal cortical carcinomas (ACC). These include serum 11-deoxycortisol, urine tetrahydro-11-deoxycortisol (THS) and pregnenetriol. Simplification of testing is important due to identification of increasing numbers of adrenal lesions.

Methods: All Scottish urine steroid profile (USP) requests with clinical details of adrenal lesion from July 2017 until April 2024 were included. One request per patient was included. Clinical details were collated from the electronic patient record to include where available size of lesion, Hounsfield units, serum androgen profile and diagnosis. Patients were excluded if no diagnosis available.

Results: Three hundred and thirty patient samples were included, 58% female, 42% male with median age 63 years, range 24-91. Patients were classified into benign adenoma (75%), ACC (6%) and other (19%). Of those with ACC, 70% were female, 30% male, median age 58 years. All ACC patients had a lesion >4 cm and 75% had abnormal USP. THS was quantifiable in 75% (15/20) of the ACC group (median 2354 µg/24hr, range 219-35286 µg/24hr) compared with 1% (3/247) of the adenoma group (range 265-610 µg /24hr). Pregnenetriol was quantifiable in 65% (13/20) of the ACC group (median 2101 µg/24hr, range 222-8373 µg/24hr) compared with 5% (13/247) of the adenoma group (range 150-806 µg/24hr). Serum androgen profile was measured in 34% patients, 60% ACC group, 34% adenoma group. The median 11-deoxycortisol result was 30.6 nmol/l, range 2.5->43.4 nmol/l in the ACC group, and 0.7 nmol/l, range <0.5-5.4 nmol/l in the adenoma group. The ACC patients with normal USP did not have serum androgen profiles measured.

Conclusion: THS, pregnenetriol and 11-deoxycortisol show promise as biomarkers, but a significant proportion of ACC are non-secretory. Serum 11-deoxycortisol is a simpler, cheaper test than USP and more appropriate for high throughput testing.