Abstract
Radiological and endocrinological work up of adrenal neoplasms is aimed at distinguishing between frequent non-functioning adenomas and rare but very aggressive adrenocortical carcinoma (ACC). Relevant research has addressed the identification of molecular, genetic and hormonal markers that could have clinical significance for malignancy, as well as a prognostic value. Regarding endocrine aspects, attention has been paid to the pattern of steroid secretion that can be affected by altered steroidogenic pathway in ACC. The advent of mass spectrometry techniques has overcome many limitations usually associated with immunoassays, allowing the determination of both common and rarely measured steroids in a single analysis with high specificity and sensitivity. Indeed, mass spectrometry strategies may be able to identify an individualized steroid profile of ACC, allowing a rapid diagnosis and a specific follow-up. In this review, insights, strengths and limitations of mass spectrometry-based approaches in steroid profiling, as well as of immunoassay in steroid measurements, will be specifically discussed. Moreover, the latest findings on steroid profiling by mass spectrometry-based techniques, the most promising analytical tool, will be summarized to evaluate if steroid profiling might be the clue for solving the clinical dilemma in differentiating ACC from non-functioning adrenocortical adenomas (ACA).
Highlights
Adrenocortical tumors (ACTs) are very common and frequently discovered incidentally on imaging performed for unrelated diseases
In patients with adrenocortical carcinoma (ACC), 18F-FDG PET is recommended in staging disease and to evaluate patients for local recurrence and distant metastases [8]
The use of LC-mass spectrometry (MS)/MS has significantly increased in clinical chemistry laboratories, for research, and for routine applications, thanks to its superior analytical specificity and to its ability to quantify a panel of analytes in a single measurement process [78,79]
Summary
Adrenocortical tumors (ACTs) are very common and frequently discovered incidentally on imaging performed for unrelated diseases. Most ACTs are small, benign, non-functioning adenomas. ACC is an orphan malignancy that has received increasing scientific attention in the last decades [2]. Relevant research on molecular pathogenesis, hormonal, genetic and epigenetic studies have been directed to clarify adrenal tumorigenesis and to identify markers of malignancy and/or prognostic significance, as well as potential therapeutic targets. Despite this increased knowledge on ACC, there are still areas of uncertainty regarding diagnosis, therapy and follow-up [2]. The evaluation of malignancy risk mainly relies on radiological
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