Steroid profiling as a biomarker tool in the diagnosis and monitoring of adrenal tumours

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Adrenal tumours are common, affecting 1-2% of the general population. However, these tumours become more common with ageing and 3% of 40-year-olds and 10% of 70-year-olds have an adrenal tumour, many of them without knowing it. The majority of adrenal tumours are discovered incidentally, mostly following an imaging procedure like CT scanning arranged for other reasons than suspected adrenal disease. Once discovered, nodules in the adrenal need to be carefully evaluated as they may overproduce hormones with a potentially detrimental effect on health and, importantly, they could be malignant, either arising from the adrenal itself or representing metastases of other malignancies. Currently we use different imaging procedures and blood tests in the work-up of patients with adrenal tumours, but this is not always informative enough and it is often difficult to decide whether an adrenal tumour is benign or malignant. We have developed a biomarker tool that measures the excretion of steroid hormones deriving from the adrenal gland in urine samples provided by adrenal tumour patients. Preliminary results indicate that there are highly significant differences in steroid hormone excretion between benign and malignant adrenal tumours. In this proposal we will validate this method by the prospective analysis of a large number of urine samples from adrenal tumour patients by our measurement technique, called gas chromatography/mass spectrometry (GC/MS). Measurement results will be analyzed in collaboration with mathematicians who will help us to identify those hormones that will inform us best about the differences between benign and malignant tumours. Use of a related technology method - liquid chromatography/ mass spectrometry, LC/MS/MS ? will then be employed for the rapid measurement of steroids, which will help to integrate our biomarker tool into routine clinical practice. Patient recruitment to this study will be driven by national and international collaborative networks including the European Network for the Study of Adrenal Tumours (ENS@T), which will ensure that we can recruit the necessary patient number during the study lifetime. This proposal links a team of experienced researchers from different disciplines, which will ensure that we succeed in improving the care of patients with adrenal tumours.