Adrenal tumors Clinical laboratory and pathology aspects

Adrenal tumors
Clinical laboratory & pathology aspects

Maryam Tohidi

Associate professor of anatomical & clinical pathology

Research Institute for Endocrine Sciences

Shahid Beheshti University of Medical Sciences

June 2019

Tehran, Iran

Important questions in approaching to an adrenal mass

1. Is the mass a hormonally active tumor? (~80% non-functional)
   • Cortisol
   • Aldosterone
   • Hormones of adrenal medulla
2. Is the mass a benign/malignant tumor?
3. Does the patient have a history of previous malignancy?

Laboratory evaluation
for
cortisol-producing adrenal tumor

1. Failure to discontinue the production of cortisol, despite the absence of ACTH stimulation
   • 1-mg overnight dexamethasone suppression test
   • low dose dexamethasone suppression test
2. Loss of a normal diurnal pattern
   • midnight/late-night salivary cortisol

III. Excess production of cortisol

4. • 24-hour urinary free cortisol (UFC test)
5. Test protocol:

• Taking 1 mg of dexamethasone orally between 11pm-12 midnight
• Blood sampling:

following morning between 8 and 9 am

5.  Interpretation (abnormal response)

• Original criterion: failure to suppress to <5 μg/dL (138 nmol/L)
• Revised criterion: failure to suppress to <1.8 μg/dL (50 nmol/L)

     providing > 95% sensitivity and 80% specificity, and serves to minimize the number of false-positive results