HYPOALDOSTERONISM ACCOMPANIED BY NORMAL OR ELEVATED MINERALOCORTICOSTEROID PATHWAY STEROID - A MARKER OF ADRENAL CARCINOMA

In order to find a biochemical marker to assist the physician in the d ifficult differential diagnosis between malignant and nonmalignant adr enal tumors, plasma levels of the mineralocorticosteroids (deoxycortic osterone, 18-hydroxydeoxycorticosterone, corticosterone, 18-hydroxycor ticosterone, and aldosterone) were determined. The same method (RIA wh ich is preceded by a crucial separation step) was used to measure all these steroids including aldosterone. The subjects included 15 adults presenting various clinical signs of adrenocortical tumors (histopatho logically: 6 with adrenal carcinoma, 1 with a history of adrenal carci noma, 1 with adrenal metastasis from other forms of cancer, 6 with ade noma, and 1 with hyperplasia). The results show that both presurgery a nd during a recurrence of adrenal carcinoma, hypoaldosteronism occurs which contrasts with the normal or even elevated levels of some aldost erone precursors. In the 7 cases of adrenal cortical carcinoma, this d ysfunction of the aldosterone pathway was detected regardless of the i mpairment of the other steroidogenesis pathways, whereas it was never found with a nonmalignant tumor. Despite the limited number of cases s o far available, these findings suggest that detection of abnormalitie s of the aldosterone pathway, and particularly the detection of hypoal dosteronism by an assay method involving a crucial steroid separating step, could contribute to a differential diagnosis between benign and malignant adrenocortical tumor and between adrenal metastasis and othe r forms of cancer.