Discussion: Adrenal Sex Steroid Testing
Most guidelines recommend testing for excess sex steroids when EITHER: 1,2
There is a high suspicion of adrenocortical carcinoma (e.g. based on imaging features)
There are signs of new excessive virilization or feminization.
The utility of such testing is largely to
Reinforce the diagnosis of ACC.2,3 ACC is responsible for more than half of cases of androgen excess
Establish baseline hormone levels, as measurements of adrenal androgens can be used as tumor markers in follow up of ACC 3
The evidence for testing these hormone levels is generally low2 and discussion of their measurement in guidelines is very brief.
Perfect consensus does not exist on which hormones should be measured. However, based on the review summarized in the table below, it seems reasonable to include:
DHEA-S
Testosterone
Estradiol
17-OH progesterone
Androstenedione
1. Rowe NE, Kumar RM, Schieda N, et al. Canadian Urological Association guideline: Diagnosis, management, and followup of the incidentally discovered adrenal mass. Can Urol Assoc J. 2023;17(2):12-24. doi:10.5489/cuaj.8248
2. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1-G34. doi:10.1530/EJE-16-0467
3. Lee JM, Kim MK, Ko SH, et al. Clinical Guidelines for the Management of Adrenal Incidentaloma. Endocrinol Metab Seoul Korea. 2017;32(2):200-218. doi:10.3803/ENM.2017.32.2.200
Last updated March 30, 2024 by Marshall Strother and Julie Hallanger-Johnson
* - indicates listed as “ancillary test” without further comment
|
Canadian Urological Association |
European Society of Endocrinology |
Korean Endocrine Society |
National Comprehensive Cancer Network Guidelines Neuroendocrine and Adrenal Tumors v1.2023 |
|
|
DHEA-S |
Y |
Y |
Y |
Y |
|
Testosterone |
Y |
Y (women) |
Y |
Y |
|
Estradiol (aka 17β-estradiol) |
Y* |
Y (men, postmenopausal women) |
Y |
N |
|
17-OH progesterone |
Y* |
Y |
In bilateral adrenal masses |
Y |
|
Androstenedione |
Y* |
Y |
Y |
Y |
|
17-OH pregnenolone |
Y* |
N |
N |
N |
|
11-deoxycorticosterone |
Y* |
N |
N |
N |
|
Progesterone |
Y* |
N |
N |
N |
