Avaliação esteroidal em pacientes com incidentalomas adrenais por cromatografia acoplada à espectrometria de massas

Abstract

Adrenal incidentalomas are masses measuring 1 cm or more, detected in the adrenal gland during routine imaging exams. Non-functioning adrenal incidentalomas (NFAIs) are characterized by the absence of excessive hormone secretion. However, in some cases, specific steroids, such as cortisol, are released, which have extensive effects on the body. Excessive cortisol release results in Cushing’s Syndrome (CS), characterized by a distinctive phenotype that facilitates diagnosis. In other cases, the release is subtle but sufficient to increase morbidity and mortality, referred to as mild autonomous cortisol secretion (MACS). Cortisol quantification is generally performed using immunoassays, which can be non-specific and generate cross-reactions. Distinguishing between patients with NFAI and MACS is crucial, as therapeutic approaches differ and may include adrenal gland removal. Therefore, this study aimed to quantify cortisol in urine and plasma using liquid chromatography and validate the respective methods. Additionally, other steroids were evaluated to observe possible alterations among the different patient classifications. The initial phase of the study involved preliminary tests prior to validation, including surrogate matrix verification. The validation followed the parameters established in RDC 166/17 by the Agência Nacional de Vigilância Sanitária. The methods were applied to a reference population and a cohort of patients from Clementino Fraga Filho University Hospital. Cortisol values in the reference population were within expected limits, with distinctions between sexes possibly attributed to contraceptive pills. In the patient cohort, statistical differences were observed between patients with CS and the control group, with and without the use of dexamethasone, an active pharmaceutical ingredient that suppresses the hypothalamic-pituitary-adrenal axis. Statistical differences were also observed between the control group and patients with NFAI, highlighting the importance of monitoring these patients and the possibility of future reclassification. Among other hormones, only androstenedione in the female cohort showed a significant difference between the control group and the group with CS, regardless of medication use.