The clinical parameters are age at diagnosis and sex of the patient, the size of the tumor by CT scanning and its density in Hounsfield units, whether it was detected incidentally or not, and whether there is evidence of hormone overproduction. “The test will utilize both clinical and laboratory data. , co-director of the clinical mass spectrometry lab and senior author of a paper describing the test. We also anticipate that the test will be able to aid in the diagnosis of inborn errors of steroid metabolism, such as congenital adrenal hyperplasia,” says Ravinder Singh, Ph.D. “Our new test for adrenal cortical carcinoma will differentiate this rare and lethal tumor from benign adrenocortical adenomas, including those that overproduce corticosteroids, or mineral steroids, or sex steroids, or those that are hormonally inactive. The test is the result of several years of analytical and clinical studies, some of which have been published in the journal Clinical Chemistry, and is based on cutting edge liquid chromatography, high-resolution, accurate-mass mass spectrometry measurement for 26 steroid metabolites in urine. Mayo Clinic’s Clinical Mass Spectrometry Laboratory has added a new, noninvasive, and more accurate test to diagnose malignant adrenal tumors, via urinary steroid profiling. In addition, patients that are believed to probably not have adrenal cancer after their workup, and those who opt out of biopsy or surgery, often still require long-term follow up with regular re-imaging and repeated hormone testing, with resultant radiation exposure and high health care costs. However, even the latter has both a high diagnostic false positive and false negative rate, and ultimately the tumor is often resected, often unnecessarily, while, on the other hand, the delays due to the diagnostic work might also compromise optimal care for those tumors that proof malignant. The sizeable group of patients with larger or denser tumors end up with an arduous workup that frequently includes additional imaging studies, hormonal testing, and biopsy. Unfortunately, CT imaging alone is very limited in its ability to distinguish benign from malignant adrenal tumors only very small and hypodense lesions can be easily dismissed as benign.
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