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Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass.

Abstract

Summary

Adrenal oncocytomas are rare tumours, with only approximately 160 cases reported in the literature. We report the use of urinary steroid profiling as part of their diagnostic evaluation and prognostication. A 45-year-old woman presented with clinical features of hyperandrogenism. Serum biochemistry confirmed androgen excess and computed tomography (CT) demonstrated a 3.2 cm adrenal tumour with density 39 HU pre-contrast. Urine steroid profiling showed elevated tetrahydro-11 deoxycortisol (THS), which is associated with adrenal malignancy. Laparoscopic adrenalectomy was performed, and histopathology diagnosed adrenal oncocytoma. Serum and urinary biochemistry resolved post-operatively and remained normal at 1-year follow-up.

Learning points

Differential diagnosis of adrenal masses is challenging. Current techniques for differentiating between tumour types lack sensitivity and specificity. 24-h urinary steroid profiling is a useful tool for reflecting steroid output from adrenal glands. Gas chromatography-mass spectrometry (GC-MS) of urinary steroid metabolites has sensitivity and specificity of 90% for diagnosing adrenocortical carcinoma. Adrenal oncocytoma are rare tumours. Differentiating between benign and malignant types is difficult. Data guiding prognostication and management are sparse.

Authors+Show Affiliations

Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia. Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia. St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia. Department of Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia. St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31778357

Citation

Lenders, N F., and J R. Greenfield. "Urinary Steroid Profiling in Diagnostic Evaluation of an Unusual Adrenal Mass." Endocrinology, Diabetes & Metabolism Case Reports, vol. 2019, 2019.
Lenders NF, Greenfield JR. Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass. Endocrinol Diabetes Metab Case Rep. 2019;2019.
Lenders, N. F., & Greenfield, J. R. (2019). Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass. Endocrinology, Diabetes & Metabolism Case Reports, 2019, doi:10.1530/EDM-19-0090.
Lenders NF, Greenfield JR. Urinary Steroid Profiling in Diagnostic Evaluation of an Unusual Adrenal Mass. Endocrinol Diabetes Metab Case Rep. 2019 Nov 28;2019 PubMed PMID: 31778357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass. AU - Lenders,N F, AU - Greenfield,J R, Y1 - 2019/11/28/ PY - 2019/09/23/received PY - 2019/11/06/accepted PY - 2019/11/29/entrez PY - 2019/11/30/pubmed PY - 2019/11/30/medline KW - 17OHP KW - 2019 KW - Acne KW - Adrenal KW - Adult KW - Amenorrhoea KW - Androstenedione KW - Androsterone KW - Australia KW - BMI KW - CT scan KW - Cortisol KW - Dexamethasone suppression KW - Fatigue KW - Female KW - Glucocorticoids KW - Hirsutism KW - Histopathology KW - Hyperandrogenism KW - LH KW - Laparoscopic adrenalectomy KW - Novel diagnostic procedure KW - November KW - Obesity KW - Testosterone KW - Urinalysis KW - Weight KW - White JF - Endocrinology, diabetes & metabolism case reports JO - Endocrinol Diabetes Metab Case Rep VL - 2019 N2 - Summary: Adrenal oncocytomas are rare tumours, with only approximately 160 cases reported in the literature. We report the use of urinary steroid profiling as part of their diagnostic evaluation and prognostication. A 45-year-old woman presented with clinical features of hyperandrogenism. Serum biochemistry confirmed androgen excess and computed tomography (CT) demonstrated a 3.2 cm adrenal tumour with density 39 HU pre-contrast. Urine steroid profiling showed elevated tetrahydro-11 deoxycortisol (THS), which is associated with adrenal malignancy. Laparoscopic adrenalectomy was performed, and histopathology diagnosed adrenal oncocytoma. Serum and urinary biochemistry resolved post-operatively and remained normal at 1-year follow-up. Learning points: Differential diagnosis of adrenal masses is challenging. Current techniques for differentiating between tumour types lack sensitivity and specificity. 24-h urinary steroid profiling is a useful tool for reflecting steroid output from adrenal glands. Gas chromatography-mass spectrometry (GC-MS) of urinary steroid metabolites has sensitivity and specificity of 90% for diagnosing adrenocortical carcinoma. Adrenal oncocytoma are rare tumours. Differentiating between benign and malignant types is difficult. Data guiding prognostication and management are sparse. SN - 2052-0573 UR - https://www.unboundmedicine.com/medline/citation/31778357/Urinary_steroid_profiling_in_diagnostic_evaluation_of_an_unusual_adrenal_mass L2 - https://edm.bioscientifica.com/doi/10.1530/EDM-19-0090 DB - PRIME DP - Unbound Medicine ER -
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