Endocrine Abstracts

JOINT1303

Background - Aim: Adrenocortical carcinomas (ACC) are rare but aggressive cancers, and the ability to differentiate between these and benign adrenocortical adenomas (ACA) is essential. Current diagnostic workup in Denmark relies on clinical assessment, functional tests, and imaging, with urinary steroid profiling as a supplementary analysis. However, no consensus exists in terms of which steroids are relevant to include in such a profile. Thus, the first aim of this study was to systematically evaluate the literature to decide on an evidently ideal steroid profile for discriminating between benign and malignant adrenocortical tumors. Secondly, the aim was to perform a retrospective study to evaluate the diagnostic value of the ideal profile.

Methods: Our systematic review was performed according to the Cochrane Collaboration guidelines. The retrospective study was done according to local hospital guidelines including relevant ethical approvals.

Results: Based on our selection criteria, our systematic review identified twelve relevant original studies. Since not all studies evaluated the same steroids or employed comparable experimental approaches, we developed a scoring system to score the apparent significance of individual steroids for inclusion in an ideal profile. With this approach, we identified seven steroids with reported high diagnostic value. Five of the seven identified steroids were already part of our routine GC/MS-generated steroid profile based on 24h urine sampling. To evaluate the diagnostic value of the proposedly ideal profile, we added the two remaining steroids to our current profile and did a retrospective study (Dec 2022 until Oct 2024) employing data from patient medical records combined with historical GC/MS data. Due to recent implementation of GC/MS, the amount of data was limited to two ACC and 41 ACA patients. Thus, we are currently planning a larger prospective study. However, both ACA cases would have been identified employing the ideal profile.

Conclusion: A systematic review revealed seven steroids with high diagnostic potential for ACC. The diagnostic potential of these metabolites was confirmed by a small retrospective study. The retrospective study further indicated that five steroid metabolites were of especially high diagnostic value, however a larger study population is needed in order to confirm these findings.