The value of dehydroepiandrosterone sulfate measurement in the differentiation between benign and malignant adrenal masses

Abstract

Objective: Owing to their increasing rate of discovery as incidental findings, the characterization of adrenal masses is an important diagnostic problem which frequently challenges the clinician's skill. Design: The results of dehydroepiandrosterone sulfate (DHEAS) measurement were evaluated in a consecutive series of 107 patients with an adrenal mass (39 men, 68 women aged 15-81 years, median 56 years). DHEAS levels observed in the patients were categorized as reduced, normal or elevated according to sex-and age-adjusted reference ranges obtained by measuring DHEAS in 214 healthy women and 142 healthy men aged 17-93 years. The working hypothesis was that a low DHEAS level is a marker of benignity. Methods: In 84 patients, the adrenal mass was discovered serendipitously, while in the remainder the mass was clinically symptomatic. Patients with known extra-adrenal malignancies were excluded. The adrenal masses were categorized as benign or malignant by computerized tomography (CT) criteria. All patients with suspected malignant tumors or with overtly hypersecreting tumors underwent adrenalectomy. The patients with a presumptive benign tumor were followed-up for at least 12 months. Results: In the overall series, the sensitivity and specificity of a low DHEAS level in the identification of a benign lesion were 41% and 100% respectively. Superimposable figures were obtained when considering only adrenal incidentalomas. DHEAS levels in adrenal cancers displayed some overlap with adrenal adenomas, but in only 2/11 adrenal cancers were DHEAS levels normal, while they were elevated in the remainder. Conclusions: The present data suggest that DHEAS measurement may help to differentiate benign from malignant adrenal masses as a complementary test of CT in a clinical research setting. The value of DHEAS measurement in general practice is limited because it may be difficult to differentiate between low and low-normal values, particularly in the elderly.

Adrenal incidentaloma: a diagnostic challenge

“…3,78 Another parameter that has been increasingly used to differentiate adrenal adenomas from non-adenomas involves radiograph absorption on unenhanced CT, known as attenuation value. 78,79 It is expressed in Hounsfield Units (HU) and is based on the fact that intracytoplasmic fat is often abundant in adrenal adenomas but rare in adrenal metastases, PHEOs or adrenocortical carcinomas. 78,79,84 Attenuation values seem to have better performance than size in diagnosing adrenal malignancy.…”

“…78,79 It is expressed in Hounsfield Units (HU) and is based on the fact that intracytoplasmic fat is often abundant in adrenal adenomas but rare in adrenal metastases, PHEOs or adrenocortical carcinomas. 78,79,84 Attenuation values seem to have better performance than size in diagnosing adrenal malignancy. 81,85 A threshold of 10 HU is the most widely advocated, 1-3,21,81,83,84,86-88 displaying a sensitivity-to-specificity ratio of 79%:96%, whereas a threshold of 0 HU changes this ratio to 47%:100%.…”

Determinants for malignancy in surgically treated adrenal lesions

“…Thus, based on our and previous results, PET seems to have merit. Urinary steroid profile [22] and DHEAS [6] have both been suggested as markers of adrenocortical carcinoma. Our data did not support a role for DHEAS and/or urinary steroid profile as risk factors for adrenal malignancy, and it was only abnormal in one and two out of eight patients with either primary or recurrent ACC, respectively.…”

Management of adrenocortical carcinoma: a consensus statement of the Italian Society of Endocrinology (SIE)

“…In many patients, the 17-OH progesterone levels are frequently increased, as well as androstenedione and, more often, DHEAS, which leads to increased plasma testosterone in females [18]. However, the predictive value of increased DHEAS levels to predict malignancy is rather low [19]. Fractionated metanephrines, along with steroid hormones assay, should be preliminarily performed in all patients affected by adrenal masses [20].…”