Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Front Endocrinol (Lausanne). 2024 Sep 18;15:1435102. doi: 10.3389/fendo.2024.1435102. eCollection 2024.
It is challenging for clinicians to distinguish adrenocortical carcinoma (ACC) from benign adrenocortical adenomas (ACA) in their early stages. This study explored the value of serum steroid profiling as a complementary biomarker for malignancy diagnosis of ACC other than diameter and explored the influence of sex and functional status.
In this retrospective study, a matched cohort of patients diagnosed with either ACC or ACA based on histopathology was meticulously paired in a 1:1 ratio according to sex, age, and functional status. Eight serum steroids including 11-deoxycortisol, 11-deoxycorticosterone, progesterone, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, and estradiol, were quantified by liquid chromatography tandem mass spectrometry. We conducted a comparative analysis of the clinical characteristics and serum steroid profiles of patients with ACC and ACA, with further subgroup analysis.
The study included 31 patients with ACC and 31 matched patients with ACA. Patients with ACC exhibited significantly larger tumor diameters, lower body mass index (BMI), and higher levels of 11-deoxycortisol, progesterone, and androstenedione than those with ACA. 11-deoxycortisol was the only valuable index for discriminating ACC from ACA, regardless of functional status and sex. Progesterone, DHEA, and DHEAS levels were higher in the functional ACC group than in the non-functional ACC group. Female ACC patients, especially in postmenopausal female exhibited higher levels of androstenedione than male patients. The area under the curve of tumor diameter, 11-deoxycortisol, and BMI was 0.947 (95% CI 0.889-1.000), with a sensitivity of 96.8% and specificity of 90.3%.
Serum steroid profiling serves as a helpful discriminative marker for ACC and ACA, with 11-deoxycortisol being the most valuable marker. For other steroid hormones, consideration of sex differences and functional status is crucial.
在早期阶段，临床医生很难将肾上腺皮质癌（ACC）与良性肾上腺皮质腺瘤（ACA）区分开来。本研究探讨了血清类固醇谱作为除直径以外用于恶性 ACC 诊断的补充生物标志物的价值，并探讨了性别和功能状态的影响。
在这项回顾性研究中，根据性别、年龄和功能状态，对基于组织病理学诊断为 ACC 或 ACA 的患者进行了精细的 1:1 配对。通过液相色谱串联质谱法定量了 11-脱氧皮质醇、11-脱氧皮质酮、孕酮、雄烯二酮、脱氢表雄酮（DHEA）、脱氢表雄酮硫酸酯（DHEAS）、17-羟孕酮和雌二醇等 8 种血清类固醇。我们对 ACC 和 ACA 患者的临床特征和血清类固醇谱进行了比较分析，并进行了进一步的亚组分析。
该研究纳入了 31 例 ACC 患者和 31 例匹配的 ACA 患者。与 ACA 患者相比，ACC 患者的肿瘤直径更大、体重指数（BMI）更低、11-脱氧皮质醇、孕酮和雄烯二酮水平更高。11-脱氧皮质醇是区分 ACC 和 ACA 的唯一有价值的指标，与功能状态和性别无关。功能性 ACC 组的孕酮、DHEA 和 DHEAS 水平高于非功能性 ACC 组。女性 ACC 患者，尤其是绝经后女性，其雄烯二酮水平高于男性患者。肿瘤直径、11-脱氧皮质醇和 BMI 的曲线下面积为 0.947（95%CI 0.889-1.000），灵敏度为 96.8%，特异性为 90.3%。
血清类固醇谱是区分 ACC 和 ACA 的有用标志物，其中 11-脱氧皮质醇是最有价值的标志物。对于其他类固醇激素，需要考虑性别差异和功能状态。
