Measurement of urinary steroid profile in patients with adrenal tumor as a screening method for carcinoma.

Minowada, Shigeru; Kinoshita, Kenji; Hara, Makoto; Isurugi, Koichiro; Uchikawa, T.; Niijima, Tadao

doi:10.1507/endocrj1954.32.29

Cited by 26 publications

(19 citation statements)

References 14 publications

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“…This indicated changes in the hepatic me tabolism of cortisol and androstendione (5a-reductase and 11 [i-hydroxysteroid dehydrogenase deficiencies). Similar results were shown by other authors [13, [15][16][17][18]. In the third patient (patient 10) normal ratios of hypersecreted cortisol metabolites were observed, this reflects hypercortisolism without alteration of their hepatic me tabolism (table 5).…”

supporting

confidence: 90%

“…tetrahydro-11-deoxycortisol (THS), this reflects 'mixed' enzyme deficiencies, and the urinary steroid profile alone is highly suggestive of an adrenal tumor [15,17], Benign or malignant adrenocortical tumors are often difficult to differentiate by pathology evaluation or tumor size [27][28][29][30], Some authors attempted to find preopera tive discrimination between this two types of tumors by determining urinary and serum steroids. They consider increased excretion of 3p-hydroxy-5-ene-steroids and/or THS (as well as serum 11-deoxycortisol) or decreased plasma corticosterone/11-deoxycorticosterone ratio as biochemical markers for malignancy [15,17,[31][32][33].…”

Section: Resultsmentioning

confidence: 99%

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Heterogeneity of Urinary Steroid Profiles in Children with Adrenocortical Tumors

Małunowicz¹,

Ginalska-Malinowska²,

Romer

et al. 1995

Horm Res

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The excretory patterns of urinary steroids determined by capillary gas chromatography in 11 children (aged 0.8-16.5 years) with adrenocortical tumors were established. In 8 patients the predominant clinical feature was virilization, in 3 others, Cushing’s syndrome. In 5 patients (3 carcinoma, 2 adenoma) very high excretion of 3β-hydroxy-5-ene steroids was observed. In 2 others (adenomas) only moderately elevated excretion of 11β-hydroxyandrosterone was found. In 1 patient (adenoma) pregnanediol dominated in the steroid profile, accompanied by moderately elevated 3β-hydroxy-5-ene steroids. Out of 3 Cushingoid patients (1 carcinoma, 2 adenomas), 1 presented an atypical urinary steroid pattern for hypercortisolemia, without 5α-reductase and 11β-hydroxysteroid dehydrogenase deficiencies. Neither the urinary steroid pattern nor tumor size alone were reliable indicators of tumor malignancy, as evaluated by a pathological examination and subsequent metastasis-free survival.

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supporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Heterogeneity of Urinary Steroid Profiles in Children with Adrenocortical Tumors

Małunowicz¹,

Ginalska-Malinowska²,

Romer

et al. 1995

Horm Res

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“…This may be explained by relatively inefficient steroid production in ACC, manifesting with increased steroid precursors, due to a dedifferentiated and thus incomplete pattern of steroidogenic enzyme expression. This appears to be supported by some case reports and a small series analyzing steroid excretion in ACC (21–24). …”

supporting

confidence: 64%

Urine Steroid Metabolomics as a Biomarker Tool for Detecting Malignancy in Adrenal Tumors

Arlt

Biehl

Taylor

et al. 2011

The Journal of Clinical Endocrinology &Amp; Metabolism

408

311

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Context:Adrenal tumors have a prevalence of around 2% in the general population. Adrenocortical carcinoma (ACC) is rare but accounts for 2–11% of incidentally discovered adrenal masses. Differentiating ACC from adrenocortical adenoma (ACA) represents a diagnostic challenge in patients with adrenal incidentalomas, with tumor size, imaging, and even histology all providing unsatisfactory predictive values.Objective:Here we developed a novel steroid metabolomic approach, mass spectrometry-based steroid profiling followed by machine learning analysis, and examined its diagnostic value for the detection of adrenal malignancy.Design:Quantification of 32 distinct adrenal derived steroids was carried out by gas chromatography/mass spectrometry in 24-h urine samples from 102 ACA patients (age range 19–84 yr) and 45 ACC patients (20–80 yr). Underlying diagnosis was ascertained by histology and metastasis in ACC and by clinical follow-up [median duration 52 (range 26–201) months] without evidence of metastasis in ACA. Steroid excretion data were subjected to generalized matrix learning vector quantization (GMLVQ) to identify the most discriminative steroids.Results:Steroid profiling revealed a pattern of predominantly immature, early-stage steroidogenesis in ACC. GMLVQ analysis identified a subset of nine steroids that performed best in differentiating ACA from ACC. Receiver-operating characteristics analysis of GMLVQ results demonstrated sensitivity = specificity = 90% (area under the curve = 0.97) employing all 32 steroids and sensitivity = specificity = 88% (area under the curve = 0.96) when using only the nine most differentiating markers.Conclusions:Urine steroid metabolomics is a novel, highly sensitive, and specific biomarker tool for discriminating benign from malignant adrenal tumors, with obvious promise for the diagnostic work-up of patients with adrenal incidentalomas.

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“…The symptoms are often diffuse and 50% of the patients have no signs of excessive hormone production (1). Various chemical methods have been used to analyse steroids in serum and urine, but owing to the low incidence of adreno¬ cortical carcinoma these studies often represent only a few cases (3)(4)(5)(6)(7). Benign and malig¬ nant adrenocortical tumours are often difficult to differentiate by histopathology, and the predictive value of findings such as nuclear polymorphism, mitotic rate, necrosis, vascular and capsular inva¬ sion are debated (2).…”

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confidence: 99%

Steroid profile in urine: a useful tool in the diagnosis and follow up of adrenocortical carcinoma

Gröndal

Eriksson

Hagenäs

et al. 1990

Acta Endocrinologica

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Measurement of urinary steroid profile in patients with adrenal tumor as a screening method for carcinoma.

Abstract: Results of measurement of urinary steroid metabolite

Cited by 26 publications

References 14 publications

Heterogeneity of Urinary Steroid Profiles in Children with Adrenocortical Tumors

Heterogeneity of Urinary Steroid Profiles in Children with Adrenocortical Tumors

Urine Steroid Metabolomics as a Biomarker Tool for Detecting Malignancy in Adrenal Tumors

Steroid profile in urine: a useful tool in the diagnosis and follow up of adrenocortical carcinoma

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