Adrenal incidentalomas: diagnostics of hormonal disorders by gas chromatography-mass spectrometry


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Abstract

Background. In order to choose the optimal treatment tactics for patients with adrenal incidentaloma (AI), the borderline values of hormonal parameters in doubtful situations require evaluation of the steroid metabolome using chromatographic methods, among which gas chromatography-mass spectrometry (GC-MS) of urine steroids is the most informative. Objective. Evaluation of the characteristics of steroid metabolism in patients with AI using metabolome analysis based on gas chromatography-mass spectrometry. Methods. Steroid urine profiles were studied by GC-MS on a SHIMADZU GCMS-QP2020 gas chromatography-mass spectrometer using liquid extraction. The functional state of the pituitary-adrenal cortex system was assessed by the immunochemiluminescent method. Results. 205 patients with AI were examined. In 29 patients with autonomous cortisol secretion of (ACS) its level after a test with 1 mg of dexamethasone was more than 140 nmol/L and in 35 patients with possible ACS (pACS) cortisol level of after a test with 1 mg of dexamethasone was less than 140 nmol/L. General chromatographic signs of a decrease in androgenic and an increase in glucocorticoid functions of the adrenal cortex, which were higher in patients with ACS, were obtained. Among 141 patients with normal results of test with 1 mg of dexamethasone, 15 (10.6%) patients showed chromatographic signs of 21-hydroxylase deficiency, 83 (58.9%) showed an increase in androgenic and mineralocorticoid functions of the adrenal glands, a positive correlation of androgens and their metabolites with a malignant potential, which must be taken into account when deciding on surgical treatment. Conclusion. Signs of decreased activity of type 2 11β-hydroxysteroid dehydrogenase and 11β-hydroxylase were common abnormalities in steroid metabolism in patients with ACS and pACS. In patients with ACS, an increase in the activity of 5β-reductase was observed; urinary excretion of tetrahydrometabolites of cortisol, cortisone, corticosterone, and 11-deoxycortisol was higher than in patients with pACS. In patients with AI with cortisol levels less than 50 nmol / L after a test with 1 mg of dexamethasone, signs of 21-hydroxylase deficiency (10.6%), an increase in androgenic and mineralocorticoid functions of the adrenal cortex, and 11β-hydroxylase and 17-hydroxylase deficiency were observed in 58.9% of patients.

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About the authors

Lyudmila I. Velikanova

North-Western State Medical University n.a. I.I. Mechnikov

Email: velikanova46@gmail.com
Dr. Biol. Sci., Professor, Head ofthe Research Chromatography Laboratory 41, Kirochnaya str., St. Petersburg 191015, Russian Federation

Z. R Shafigullina

North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

N. V Vorokhobina

North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

E. V Malevanaya

North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

Zh. V Paltsman

North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

A. V Kuznetsova

North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

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