Measurement of urinary steroid profile in patients with adrenal tumor as a screening method for carcinoma.

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Abstract
Results of measurement of urinary steroid metabolite profile using gas chromatographic analysis in 8 patients with adrenocortical tumors, i.e., 3 adenomas with Cushing''s Syndrome, 1 adenoma with virilization, 1 adenoma without clinical manifestations, 1 carcinoma with Cushing''s syndrome and virilization, 1 carcinoma with Cushing''s syndrome and feminization and 1 carcinoma without endocrinological symptoms, are reported. A unique pattern dominated by 5.beta. and 11.beta.-hydroxy steroid metabolites was confirmed in 5 patients with Cushing''s syndrome consisting of 3 cases with adenomas and 2 with carcinomas. Excessive 3.alpha., 17.alpha., 21-trihydroxy-5.beta.-pregnan-20-one (tetrahydro-11-deoxycortisol, THS) and .DELTA.5-pregnene-3.beta., 11.alpha. 20.alpha.-triol (.DELTA.5-pregnenetriol) values were found in all 3 carcinomas including a nonfunctional carcinoma. The tumor apparently is a carcinoma, although excessive excretion of THS and .DELTA.5-pregnentriol was detected in 1 patient with a large adenoma associated with virilization. One patient with carcinoma was responsive to ACTH stimulation while the remainder show almost no response to exogenous ACTH. Urinary steroid profiling using gas chromatographic analysis, especially the values for THS and .DELTA.5-pregnenetriol, appears to be a useful method to use in detecting these steroid metabolic characteristics in patients with adrenocortical carcinoma.