Endocrine Abstracts

EURINE-ACT study (Bancos et al, Lancet 2020) proposed a ‘triple test’, incorporating Urine Steroid Profiles (USP) in adrenal cancer assessment in nodules over 4 cm and density above 20 Hounsfield Units (HU) on imaging. Without an agreed local protocol, USP testing was audited to evaluate its use, alongside other investigations of autonomous adrenal secretion. 44 patients had USP (41 spot urine, 3 x24hr collection) for investigation of adrenal nodules (from 467 referrals August 2022 to April 2025). 23 samples were completed for >4 cm and >20HU or unclassified on post-contrast images, 12 for <4 cm but >20HU or unclassified, 9 samples with <20HU. 32 had normal USP, 9 had elevated cortisol metabolites (deemed unsuitable for interpretation on random sampling), 3 had metabolites consistent with Adrenocortical Carcinoma (ACC). Of the positive USP, 1 patient had confirmed ACC on histology, with 2 unable to exclude ACC; diagnosed as myelolipoma and cortical adenoma (cortisol secreting). Of note, another patient had malignancy of unknown potential on histology with normal USP but abnormal cortisol dynamics on serum and salivary testing. The normal USP may allow a more favourable approach in follow-up post adrenalectomy. In this small cohort, USP aided differentiation between adrenal cancer and an isolated metastasis from previous cancer. Of those who underwent an adrenalectomy, the USP was not a differentiating factor in the decision to operate. Whilst EURINE-ACT proposed only testing >4 cm and >20HU, in this cohort a significant number of USP were performed without meeting these criteria. It may add value when differentiating from other retroperitoneal masses, or potential ovarian malignancies with raised testosterone, or for seemingly non-secretory lesions suspicious of ACC and as a marker for early recurrence in proven ACC. However, it is not currently going to replace other cortisol excess investigations and unlikely to directly influence surgical decisions in indeterminate adrenal incidentalomas.