PLASMA-LEVELS OF ALDOSTERONE VERSUS ALDOSTERONE PRECURSORS - A WAY TOESTIMATE THE MALIGNANCY OF ASYMPTOMATIC AND NONSECRETORY ADRENAL-TUMORS - A FRENCH RETROSPECTIVE MULTICENTRIC STUDY

The aim of this study was to find out whether the dysfunction of aldos terone pathway, previously proposed as a marker of secretory adrenal c arcinoma, is also found in nonsecretory adrenal carcinomas, which pose even more difficult diagnostic problems even for patients with hypert ension accompanied or not by hypokalemia. The exploration consisted of using the same method (RIA preceded by a chromatographic step) to det ermine the plasma levels of the following steroids in the mineralocort icosteroid pathway: deoxycorticosterone (DOG), 18-hydroxydeoxycorticos terone (18-OHDOC), corticosterone (B), 18 hydroxycorticosterone (18 OH B), and aldosterone. The subjects included 16 adults, each presenting with an endocrinologically asymptomatic adrenal mass associated for s ome patients with hypokalemia and hypertension (8 with adrenal carcino ma, 2 with adrenal metastasis from other forms of cancer, and 6 adenom as). These results show that even in nonsecretory adrenal carcinoma, t here is a dysfunction of the aldosterone pathway, which can be evaluat ed from the ratio between aldosterone and the substrate of 11 beta hyd roxylase (DOG) and its derivative (18-OH DOC). This study suggests tha t exploration of mineralocorticosteroid pathway can be used as a hormo nal marker of adrenal carcinoma for both secretory and non-secretory m alignant masses.