Table 3.
Studies on urine steroid profiling for diagnosis of ACC.
| Author, year | Samples | Type of study | USP | Methods | Findings | Reference |
|---|---|---|---|---|---|---|
| Gröndal et al. (1990) | 24ACC, 10 CS, 8PA, 16control | prospective | Not known | GC-MS | 3β-hydroxy-5-ene steroids and/or metabolites of cortisol precursors, such as THS were increased in ACC | (53) |
| Alrt et al. (2011) | 45ACC, 102ACA | Retrospective | 32 metabolites | GC-MS | Increased nine steroids in ACC (5-PD, 5-PT, DHEA, 16ɑ-OH-DHEA, THDOC, 5ɑ-THDOC, PD, PT, THS) | (54) |
| THS, 5-PT, and 5-PD were most informative steroids in discriminating ACC from ACA | ||||||
| Kerkhofs et al. (2015) | 27ACC, 107ACA, 18 other adrenal conditions | Retrospective | 22 metabolites | GC-MS | THS was the most informative maker and excretion of THS was associated with ACC tumor size and stage. | (55) |
| THS at a cut-off value of 2.35µmol/24 h differentiated ACC from other adrenal disorders with 100% sensitivity and 99% specificity | ||||||
| No significant differences in metabolite excretion between functioning and non-functioning ACC | ||||||
| Velikanava et al. (2016) | 31 ACC, 108 ACA | Retrospective | 66 metabolites | LC-MS and GC- MS | 100% sensitivity and specificity of ACC and ACA differential diagnosis can be achieved by combining several parameters of urine steroids. | (56) |
| Increased THS in 74.2% of patients with ACC | ||||||
| Increased DHEA and its metabolites in 67.7% of patients with ACC | ||||||
| Hines et al. (2017) | 114 control, 71 adrenal disease | Retrospective | 26 metabolites | HRAM LC-MS | 11 steroids with increased Z score, especially tetrahydro-11-deoxycortisol, pregnanetriol, and 5-pregnenetriol | (57) |
| Shafigullina et al. (2018) | 26 control, 103AI | Retrospective | 66 metabolites | GC-MS | Increased THS, androgens and progestenes in ACC | (58) |
| Bancos et al. (2020) | 98ACC, 1919 non-ACC mass | Prospective | 15 Metabolites | LC-MS/MS | USP indicating high risk of ACC were seen in 83 (84.7%) of 98 ACC and 157 (8.2%) of 1919 non-ACC masses | (59) |
ACC, adrenocortical carcinoma; CS, Cushing’s syndrome; PA, primary hyperaldosteronism; ACA, adrenocortical adenoma; GC-MS, gas chromatography-mass spectrometry; DHEA, dehydroepiandrosterone; USP, urine steroid profile; 5-PD, pregnanediol; THS, tetrahydro-11-deoxycortisol; HRAM LC-MS, liquid-chromatography; high-resolution; accurate-mass mass spectrometry; LC-MS, liquid-chromatography mass spectrum.