ccfDNA concentrations in adrenal pheochromocytoma and other adrenal tumours

Onesimu Ezra David; Lorenzo Tucci; Ana Crastin; Miriam Asia; Oskar Podstawka; Mengjie Xu; John Ayuk; Vasileios Chortis; Ronchi Cristina L

doi:10.1530/endoabs.117.P93

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Endocrine Abstracts (2026) 117 P93 | DOI: 10.1530/endoabs.117.P93

SFEBES2026 Poster Presentations Endocrine Cancer and Late Effects (12 abstracts)

ccfDNA concentrations in adrenal pheochromocytoma and other adrenal tumours

Ezra David Onesimu ¹ , Lorenzo Tucci ^1,2 , Ana Crastin ¹ , Miriam Asia ³ , Oskar Podstawka ¹ , Mengjie Xu ^1,4 , John Ayuk ³ , Vasileios Chortis ^1,3 & Cristina L Ronchi ^1,3

Author affiliations

¹Department of Metabolism and Systems Science, University of Birmingham, Birmingham, United Kingdom; ²Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy; ³Department of Endocrinology, Queen Elizabeth Hospital Birmingham NHS Trust, Birmingham, United Kingdom; ⁴Department of Endocrinology, Taihe Hospital, Hubei University of Medicine, China

Background: Circulating cell-free DNA (ccfDNA) is a promising biomarker in adrenal neoplasms. Previous studies showed elevated ccfDNA levels in adrenocortical carcinoma (ACC) compared with endocrine inactive adenomas (EIA) and healthy subjects (HS), but data in pheochromocytoma (Pheo) are limited. Objectives To assess total ccfDNA concentrations in Pheo compared with other adrenal tumour types and HS, and to explore potential correlations with plasma metanephrine (MN) and normetanephrine (NMN) levels.

Methods: We analysed a cohort of 37 patients with adrenal tumours: Pheo (n = 6; 1 female; median age 64.5 years), EIA (n = 13; 8 females; 56 years), or ACC (n = 18; 13 females; 50 years). Fifteen healthy subjects (HS; 8 females; 34 years) served as controls. Peripheral blood samples were collected at baseline. ccfDNA was isolated using a commercial extraction kit and quantified by fluorimetry, with integrity verified via Tapestation analysis. Plasma MN and NMN levels were quantified using liquid chromatography–tandem mass spectrometry following our institutional diagnostic protocol. Statistical tests were performed to compare ccfDNA concentrations among tumour groups and to evaluate associations with clinical and biochemical parameters.

Results: Median ccfDNA concentrations were 0.069 ng/µl in Pheo (range 0.001–0.320), 0.091 ng/µl in EIA (0.042–0.253), 0.263 ng/µl in ACC (0.049–1.680), and 0.025 ng/µl in HS (0–0.186). Overall group differences were significant (P = 0.047, Kruskal–Wallis test). ACC had higher ccfDNA levels than EIA (P = 0.024) and HS (P = 0.001), while Pheo values were comparable to EIA and HS. No significant correlations were observed between ccfDNA and age, tumour size, or plasma MN/NMN levels.

Conclusions: ccfDNA concentrations in Pheo resemble those in benign adenomas and healthy controls but are lower than in ACC. These findings support the potential of ccfDNA as a minimally invasive biomarker to aid in distinguishing adrenal tumour types.