Department of Medical and Surgical Sciences, Endocrinology Unit and Center for Applied Biomedical Research (CRBA), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Curr Opin Endocrinol Diabetes Obes. 2019 Jun;26(3):160-165. doi: 10.1097/MED.0000000000000475.
Liquid chromatography-tandem mass spectrometry (LC-MS/MS), allowing the reliable measurement of large panels of steroids, opened a new era in the characterization of adrenal diseases. This review summarizes the most recent findings on serum steroid profile in benign adrenocortical tumors and provides a focus on the most promising analytical developments.
Recently developed LC-MS/MS assays included challenging compounds, providing new knowledge on adrenal steroid secretion. Pioneering studies highlighted the potential of incoming technologies in increasing measurement selectivity and implementing the steroidomic approach. In primary aldosteronism, several studies highlighted the signature of aldosterone-producing adenomas, mainly characterized by secretion of hybrid steroids. The combination of steroid panel and radiological data reached an agreement with adrenal vein sampling-based classification in more than 80% of the cases. The serum steroid profiling in patients with Cushing's syndrome, mainly characterized by reduced androgens and increased 11-dexoycorticosterone in adrenal hypercortisolism, showed a good discriminant power for patients' subtyping (90% correct classification rate). Finally, a selected panel of steroids, including 11-deoxycortisol as the main discriminant compound, was able to achieve a good separation of patients with and without adrenocortical carcinomas.
The constantly evolving serum steroid profiling by MS may improve the diagnosis of different types of adrenocortical tumors.
液相色谱-串联质谱（LC-MS/MS）能够可靠地测量大量类固醇，为肾上腺疾病的特征分析开辟了新纪元。本综述总结了良性肾上腺皮质肿瘤血清类固醇谱的最新发现，并重点介绍了最有前途的分析进展。
最近开发的 LC-MS/MS 检测方法包括了具有挑战性的化合物，为肾上腺类固醇分泌提供了新的知识。开创性的研究强调了新技术在提高测量选择性和实施类固醇组学方法方面的潜力。在原醛症中，几项研究强调了醛固酮瘤的特征，主要表现为混合类固醇的分泌。类固醇谱和影像学数据的组合在超过 80%的病例中与基于肾上腺静脉取样的分类达成一致。库欣综合征患者的血清类固醇谱主要表现为雄激素减少和 11-脱氧皮质酮增加，对患者亚型的区分具有很好的判别能力（正确分类率为 90%）。最后，一组选定的类固醇，包括作为主要判别化合物的 11-脱氧皮质醇，能够很好地区分有和无肾上腺皮质癌的患者。
MS 不断发展的血清类固醇谱分析可能改善不同类型肾上腺皮质肿瘤的诊断。
