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Urinary glucocorticoid metabolites: biomarkers to classify adrenal incidentalomas?
Author(s) -
Brossaud Julie,
Ducint Dominique,
Corcuff JeanBenoît
Publication year - 2016
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12717
Subject(s) - medicine , endocrinology , glucocorticoid , metabolite , area under the curve , receiver operating characteristic , urinary system , analyte , hydrocortisone , population , logistic regression , urine , chemistry , chromatography , environmental health
Summary Objective Total urinary cortisol metabolites represent cortisol production and metabolism. We hypothesized that to assay metabolites could add some information to the one provided by a sole cortisol assay. Design and patients We set up an inexpensive multiplex mass spectrometry assay to quantify cortisol metabolites. We investigated 43 patients with benign secreting ( AT +) or silent ( AT −) adrenal tumours compared to 48 lean ( Nl ) or 143 obese (Ob) subjects, and to 26 patients with a Cushing's disease ( CD ). The initial investigation included immunoreactive quantification of urinary free cortisol ( UFC ). Results Cortisol metabolites were overexcreted in CD but not in Ob subjects. Nl and Ob were thus pooled in a control population (Ctl). Cortisol, tetrahydrocortisol ( THF ) and tetrahydrocortisone ( THE ) excretions were significantly increased in AT compared to Ctl subjects, whereas immunoreactive UFC was similar. A logistic regression retaining cortisol, THF , and α‐ and β‐cortolone as significant analytes allowed the construction of a receiver‐operating characteristics ( ROC ) curve significantly better than the curve generated by cortisol alone (area under the curve ( AUC ) 0·927 vs 0·729, respectively; P < 0·0001). More importantly, although there was no significant difference between Ctl vs AT− subjects for cortisol metabolites, a logistic regression retaining cortisol, allo‐THF, and α‐ and β‐cortolone as significant analytes generated a ROC curve performing significantly better than cortisol alone ( AUC 0·910 vs 0·635, respectively; P < 0·0001). Conclusion Cortisol metabolite excretion is modified in AT , including AT −, patients even without modification of UFC . Clinical usefulness of these biomarkers has to be investigated in prospective studies following up patients with AT .