RESUMEN
Immunochemical methods of analysis are traditionally used for diagnosis of various forms of Cushing's syndrome (CS). In the presence of boundary values of hormonal parameters, doubtful situations, a combination of changes both in pituitary and in adrenal glands, it is useful to determine additional differential diagnostic criteria for the diagnosis of various forms of CS. Urinary steroid profiles (USP) were analyzed by gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography (HPLC) for 38 females with adrenal Cushing's syndrome (CSA), 42 females with pituitary CS (CSP) and 25 healthy females (control group). An increase of free cortisol/free cortisone ratio in the urine (UFF/UFE) for CSP patients in comparison of CSA was obtained by HPLC method. Decreased urinary excretion of UFF and UFE by more than 60% after the 8 mg dexamethasone suppression test had 100% sensitivity and specificity of more than 90% for the diagnosis of CSP. GC-MS method in patients with CSA and CSG revealed the peculiarities of androgens, progestins and glucocorticoids metabolism which leaded to obtain specific USP for CS of different genesis. Increased urinary excretions of dehydroepiandrosterone and its metabolites, metabolites of androstenedione, the ratio of sum of cortisol and cortisone tetrahydrometabolites to tetrahydro-11-deoxycortisol (more then 36) in CSP patients compared with CSA are additional signs for differential diagnosis of these diseases. The combination of classical tests and USP obtained by HPLC and GC-MS methods increased the sensitivity and specificity of differential diagnosis of CSA and CSP.
Asunto(s)
Cromatografía Líquida de Alta Presión , Cortisona , Síndrome de Cushing , Cortisona/análisis , Síndrome de Cushing/diagnóstico , Dexametasona , Diagnóstico Diferencial , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , HidrocortisonaRESUMEN
The metabolomics of urinary steroids was studied by gas chromatography-mass spectrometry in 25 patients with Cushing's syndrome without malignant potential and in 12 patients with malignant potential of adrenal neoplasms (Weiss score 1-3). Patients with adrenocortical adenoma (N=24) constituted the control group. In patients with Cushing's syndrome and malignant potential, increased urinary excretion of 16-oxo-androstendiol, tetrahydro-11-deoxycortisol, and 16-hydroxypregnendiol, which had 100% specificity and sensitivity >90% for the diagnosis of malignant potential. Additionally, non-classical 5-ene-pregnenes (16-OHpregnenolone, 21-OH-pregnenolone, 3ß,16,20-pregnentriol, and 3ß,17,20-pregnentriol) were identified. The revealed changes in the metabolomics of steroids can be early signs of malignant potential in patients with Cushing's syndrome. In patients with malignant potential, three signs of reduced activity of 11ß-hydroxysteroid dehydrogenase type 2 were detected and in patients without malignant potential, one sign was found. In patients with and without malignant potential, three signs increased activity of 5ß-reductase were found.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Adenoma Corticosuprarrenal/diagnóstico , Biomarcadores de Tumor/orina , Síndrome de Cushing/diagnóstico , Metabolómica/métodos , 11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 2/orina , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/orina , Adenoma Corticosuprarrenal/complicaciones , Adenoma Corticosuprarrenal/patología , Adenoma Corticosuprarrenal/orina , Adulto , Androstenodioles/orina , Cortodoxona/análogos & derivados , Cortodoxona/orina , Síndrome de Cushing/complicaciones , Síndrome de Cushing/patología , Síndrome de Cushing/orina , Detección Precoz del Cáncer , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Oxidorreductasas/orina , Pregnenodionas/orina , Pregnenos/orina , Pregnenolona/orinaRESUMEN
Urinary steroid profiling (USP) was studied using high-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) methods in 108 patients with adrenocortical adenoma (ACA) and in 31 patients with adrenocortical carcinoma (ACC). Thirteen ACC and Cushing's syndrome (ACC-CS) patients had two types of USP as well as 18 ACC patients without hypercortisolism. These four types differed by androgen and glucocorticoid secretion of the adrenal cortex. Fifteen main ACC features were observed by GC-MS. Urinary excretion of dehydroepiandrosterone (DHEA) was increased in 67.7 % of ACC patients and tetrahydro-11-deoxycortisol (THS) in 74.2 %. By combination of the following parameters: THS >900 µg/24 h and/or DHEA >1500 µg/24 h with ratios of 3α,16,20-pregnentriol/3ß,16,20-pregnentriol (3α,16,20dP3/3ß,16,20dP3) less than 6.0 and 3α,17,20dP3/3ß,17,20dP3 less than 9.0 and the detection of "non-classical" 5-en-pregnens, not found in ACA and healthy persons, 100 % sensitivity and specificity of ACC and ACA differential diagnosis were achieved. Features of 21-hydroxylase and 11ß-hydroxylase deficiency were observed by GC-MS in 32.2 and 61.3 % of the ACC patients, respectively. Additional features for ACC-CS diagnostic were increased urinary excretion of 6ß-hydroxycortisol, 18-hydroxycorticosterone, the sum (UFF + UFE) obtained by HPLC, tetrahydrocorticosterone, and the sum (THF + THE + allo-THF) obtained by GC-MS.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/orina , Adenoma Corticosuprarrenal/orina , Carcinoma Corticosuprarrenal/orina , Cromatografía Líquida de Alta Presión/métodos , Cromatografía de Gases y Espectrometría de Masas/métodos , Esteroides/orina , Neoplasias de la Corteza Suprarrenal/diagnóstico , Adenoma Corticosuprarrenal/diagnóstico , Carcinoma Corticosuprarrenal/diagnóstico , Adulto , Cortodoxona/análogos & derivados , Cortodoxona/orina , Síndrome de Cushing/orina , Deshidroepiandrosterona/orina , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esteroide 11-beta-Hidroxilasa/metabolismo , Esteroide 21-Hidroxilasa/metabolismo , Adulto JovenRESUMEN
A hundred and ninety-one patients with different adrenal cortical tumors were studied to assess the diagnostic value of HPLC of corticosteroids in the biological fluids. HPLC of corticosteroids in the biological fluids revealed the signs of the hormonal activity of incidentalomas, organic endogenous hypercorticism, and mass malignancy. Some patients with adrenal cortical incidentalomas (15.5%) were found to have impaired steroid formation that is typical of 11ß-OH- or 17-OH-hydroxylase deficiencies. The findings allow one to diagnose adrenal disorders at the early stages of disease and to define indications for surgical treatment.