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HelpTest Code ACC Adrenal Mass Panel, 24 Hour, Urine
Reporting Name
Adrenal Mass Panel, 24 Hr, UPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Useful For
Aiding in assessing malignancy in adrenal masses
May aid in improving diagnostic and prognostic prediction and dissect disease mechanisms for the following applications:
-Diagnostic assessment and follow up of adrenal cortical carcinoma
-Differential diagnostic assessment of adrenal tumors
-Additional assessment related to Cushing syndrome, mild autonomous cortisol secretion, primary aldosteronism, inborn errors of steroidogenesis, polycystic ovary syndrome
This test is not useful for establishing eligibility for a specific treatment as results must be interpreted in conjunction with the clinical status of the patient.
Method Name
Liquid Chromatography Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
Shipping Instructions
Ship specimens frozen.
Necessary Information
The following information is required. Testing cannot proceed without this information (NA or Not Applicable are not acceptable responses).
-Age at diagnosis (Years, not offered for pediatric patients)
-Gender (Male, Female)
-Mode of discovery (incidental, cancer staging, other)
-Tumor diameter (mm)
-Unenhanced computerized tomography (CT) (Hounsfield units)
-Hormonal excess (Yes = Present, No=Absent)
-Collection duration in hours and 24-hour volume in milliliters
If information is not provided within 5 days of specimen receipt at MCL, testing may be delayed or canceled.
If not ordering electronically, Adrenal Mass Panel Patient Information is required.
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Container/Tube: Plastic urine tube
Specimen Volume: 4 mL
Collection Instructions:
1. Collect urine for a full 24 hours (required) and record the total volume.
2. Do not add preservatives. Specimens containing preservatives will be canceled.
3. Entire 24 hour collection must be mixed well prior to aliquoting into a 5 mL plastic tube.
Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens for multiple collections.
Specimen Type
UrineSpecimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Frozen (preferred) | 90 days | |
| Refrigerated | 14 days |
Reject Due To
| Gross hemolysis | OK |
| Gross icterus | OK |
Reference Values
Note: Due to the wide range of urine steroid metabolite concentrations seen in healthy individuals and their skewed distribution, the reference values are based on the back calculated ± 3SD of log transformed data.
Males 18-49 years:
Androsterone: 182-29,212 mcg/24 h
Etiocholanolone: 133-23,272 mcg/24 h
Dehydroepiandrosterone: <5-81,554 mcg/24 h
16a-OH-Dehydroepiandrosterone: 13-29,945 mcg/24 h
5-Pregnenetriol: 23-7,328 mcg/24 h
5-Pregnenediol: 13-2,823 mcg/24 h
Tetrahydro-11-Corticosterone: 8-1,961 mcg/24 h
Tetrahydro-11-Deoxycorticosterone: <5-316 mcg/24 h
Pregnanediol: 12-3,812 mcg/24 h
17a-OH-Pregnanolone: 15-2,466 mcg/24 h
Pregnanetriol: 66-9,409 mcg/24 h
Pregnanetriolone: <5-550 mcg/24 h
Tetrahydrodeoxycortisol: 7-1520 mcg/24 h
Cortisol: <5-903 mcg/24 h
6B-OH-Cortisol: 13-2,303 mcg/24 h
Tetrahydrocortisol: 152-22,723 mcg/24 h
5a-Tetrahydrocortisol: 157-24,059 mcg/24 h
B-Cortol: 30-5,115 mcg/24 h
11B-OH-Androsterone: 108-11,987 mcg/24 h
11B-OH-Etiocholanolone: 22-8,312 mcg/24 h
Cortisone: 12-842 mcg/24 h
Tetrahydrocortisone: 271-44,355 mcg/24 h
a-Cortolone: 140-14,885 mcg/24 h
B-Cortolone: 72-9,740 mcg/24 h
11-Oxoetiocholanolone: 70-8,446 mcg/24 h
Males ≥50 years:
Androsterone: 118-25,389 mcg/24 h
Etiocholanolone: 127-15,640 mcg/24 h
Dehydroepiandrosterone: 7-4,260 mcg/24 h
16a-OH-Dehydroepiandrosterone: 11-6,183 mcg/24 h
5-Pregnenetriol: 24-2,162 mcg/24 h
5-Pregnenediol: 17-1,296 mcg/24 h
Tetrahydro-11-Corticosterone: 16-1,674 mcg/24 h
Tetrahydro-11-Deoxycorticosterone: <5-297 mcg/24 h
Pregnanediol: 23-1,846 mcg/24 h
17a-OH-Pregnanolone: 18-1,747 mcg/24 h
Pregnanetriol: 115-5,432 mcg/24 h
Pregnanetriolone: 5-221 mcg/24 h
Tetrahydrodeoxycortisol: 12-1,277 mcg/24 h
Cortisol: 12-597 mcg/24 h
6B-OH-Cortisol: 22-2,406 mcg/24 h
Tetrahydrocortisol: 331-19,009 mcg/24 h
5a-Tetrahydrocortisol: 155-35,266 mcg/24 h
B-Cortol: 56-3,541 mcg/24 h
11B-OH-Androsterone: 142-13,135 mcg/24 h
11B-OH-Etiocholanolone: 69-6,805 mcg/24 h
Cortisone: 24-732 mcg/24 h
Tetrahydrocortisone: 454-34,576 mcg/24 h
a-Cortolone: 211-17,591 mcg/24 h
B-Cortolone: 114-8,434 mcg/24 h
11-Oxoetiocholanolone: 155-7,174 mcg/24 h
Females 18-49 years:
Androsterone: 90-29,625 mcg/24 h
Etiocholanolone: 127-24,568 mcg/24 h
Dehydroepiandrosterone: <5-12,317 mcg/24 h
16a-OH-Dehydroepiandrosterone: 5-31,248 mcg/24 h
5-Pregnenetriol: 17-4,166 mcg/24 h
5-Pregnenediol: 6-2,900 mcg/24 h
Tetrahydro-11-Corticosterone: 13-1,548 mcg/24 h
Tetrahydro-11-Deoxycorticosterone: <5-833 mcg/24 h
Pregnanediol: 8-44,760 mcg/24 h
17a-OH-Pregnanolone: 7-3,208 mcg/24 h
Pregnanetriol: 50-9,768 mcg/24 h
Pregnanetriolone: <5-139 mcg/24 h
Tetrahydrodeoxycortisol: 7-1,047 mcg/24 h
Cortisol: 11-642 mcg/24 h
6B-OH-Cortisol: 22-2,061 mcg/24 h
Tetrahydrocortisol: 185-16,515 mcg/24 h
5a-Tetrahydrocortisol: 45-22,591 mcg/24 h
B-Cortol: 28-4260 mcg/24 h
11B-OH-Androsterone: 59-12,462 mcg/24 h
11B-OH-Etiocholanolone: 32-6,354 mcg/24 h
Cortisone: 19-749 mcg/24 h
Tetrahydrocortisone: 262-32,461 mcg/24 h
a-Cortolone: 207-13,931 mcg/24 h
B-Cortolone: 63-7,489 mcg/24 h
11-Oxoetiocholanolone: 63-7,449 mcg/24 h
Females ≥50 years:
Androsterone: 32-10,134 mcg/24 h
Etiocholanolone: 52-10,946 mcg/24 h
Dehydroepiandrosterone: <5-10,046 mcg/24 h
16a-OH-Dehydroepiandrosterone: <5-9,982 mcg/24 h
5-Pregnenetriol: 10-1,901 mcg/24 h
5-Pregnenediol: <5-2,732 mcg/24 h
Tetrahydro-11-Corticosterone: 14-1,229 mcg/24 h
Tetrahydro-11-Deoxycorticosterone: <5-123 mcg/24 h
Pregnanediol: 8-2,138 mcg/24 h
17a-OH-Pregnanolone: <5-571 mcg/24 h
Pregnanetriol: 26-3,444 mcg/24 h
Pregnanetriolone: <5-348 mcg/24 h
Tetrahydrodeoxycortisol: 8-801 mcg/24 h
Cortisol: 9-336 mcg/24 h
6B-OH-Cortisol: 25-1,365 mcg/24 h
Tetrahydrocortisol: 237-14,050 mcg/24 h
5a-Tetrahydrocortisol: 92-12,604 mcg/24 h
B-Cortol: 29-3289 mcg/24 h
11B-OH-Androsterone: 86-9,280 mcg/24 h
11B-OH-Etiocholanolone: 40-7,002 mcg/24 h
Cortisone: 15-555 mcg/24 h
Tetrahydrocortisone: 359-24,320 mcg/24 h
a-Cortolone: 125-17,472 mcg/24 h
B-Cortolone: 82-5,784 mcg/24 h
11-Oxoetiocholanolone: 78-6,571 mcg/24 h
Reference values have not been established for patients who are younger than 18 years of age.
Interpretation
Test provides clinical risk values based on clinical data alone as well as integrated risk values based on clinical data in combination with biochemical steroid data. Reported risk values correspond to the probability of a malignant adrenal cortical carcinoma or other malignancy (eg, sarcoma, lymphoma) as well as the probability of a benign mass (eg, adenoma, myelolipoma, cyst).
Test results provide the referring physician with probabilities for a variety of outcomes, thereby aiding the interpretation of clinical status and optimal paths for further investigation, if any, based on an informed discussion between provider and patient. Test results should always be interpreted in conjunction with all other clinical findings as they cannot be interpreted as absolute evidence for the presence or absence of malignant disease.
For more information see Adrenal Mass Panel Clinical Data Definition of Malignancy Predictors.
Day(s) Performed
Monday
Report Available
7 to 18 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
0015M
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ACC | Adrenal Mass Panel, 24 Hr, U | 95556-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 607276 | ACC - Clinical Risk | 95787-8 |
| 607277 | Other Malignancy - Clinical Risk | 95788-6 |
| 607278 | Benign Mass - Clinical Risk | 95789-4 |
| 607279 | ACC - Integrated Risk | 95790-2 |
| 607280 | Other Malignancy - Integrated Risk | 95791-0 |
| 607281 | Benign Mass - Integrated Risk | 95792-8 |
| 607282 | Interpretation | 73884-9 |
| 607333 | Comment | 77202-0 |
| AC1AG | Age at Diagnosis | 63932-8 |
| AC2GD | Gender | 76691-5 |
| AC3MD | Mode of Discovery | 95557-5 |
| AC4TZ | Tumor Diameter (mm) | 21889-1 |
| AC5HX | Unenhanced CT (Hounsfield Units) | 95558-3 |
| AC6HM | Hormonal Excess | 95559-1 |
| TM66 | Collection Duration (h) | 13362-9 |
| VL66 | Volume (mL) | 3167-4 |
| 607283 | Androsterone | 6705-8 |
| 607284 | Androsterone Z-score | 95560-9 |
| 607285 | Etiocholanolone | 2268-1 |
| 607286 | Etiocholanolone Z-score | 95561-7 |
| 607287 | Dehydroepiandrosterone | 13612-7 |
| 607288 | Dehydroepiandrosterone Z-score | 95562-5 |
| 607289 | 16a-OH-Dehydroepiandrosterone | 95563-3 |
| 607290 | 16a-OH-DHEA Z-score | 95564-1 |
| 607291 | 5-Pregnenetriol | 95565-8 |
| 607292 | 5-Pregnenetriol Z-score | 95566-6 |
| 607293 | 5-Pregnenediol | 95567-4 |
| 607294 | 5-Pregnenediol Z-score | 95568-2 |
| 607295 | Tetrahydro-11-Corticosterone | 95569-0 |
| 607296 | TH-11-Corticosterone Z-score | 95570-8 |
| 607297 | Tetrahydro-11-Deoxycorticosterone | 95571-6 |
| 607298 | TH-11-Deoxycorticosterone Z-score | 95572-4 |
| 607299 | Pregnanediol | 2834-0 |
| 607300 | Pregnanediol Z-score | 95573-2 |
| 607301 | 17a-OH-Pregnanolone | 95574-0 |
| 607302 | 17a-OH-Pregnanolone Z-score | 95575-7 |
| 607303 | Pregnanetriol | 2836-5 |
| 607304 | Pregnanetriol Z-score | 95576-5 |
| 607305 | Pregnanetriolone | 50643-6 |
| 607306 | Pregnanetriolone Z-score | 95577-3 |
| 607307 | Tetrahydrodeoxycortisol | 2996-7 |
| 607308 | Tetrahydrodeoxycortisol Z-score | 95578-1 |
| 607309 | Cortisol | 14158-0 |
| 607310 | Cortisol Z-score | 95579-9 |
| 607311 | 6B-OH-Cortisol | 13611-9 |
| 607312 | 6B-OH-Cortisol Z-score | 95580-7 |
| 607313 | Tetrahydrocortisol | 2995-9 |
| 607314 | Tetrahydrocortisol Z-score | 95581-5 |
| 607315 | 5a-Tetrahydrocortisol | 21044-3 |
| 607316 | 5a-Tetrahydrocortisol Z-score | 95582-3 |
| 607317 | B-Cortol | 53634-2 |
| 607318 | B-Cortol Z-score | 95583-1 |
| 607319 | 11B-OH-Androsterone | 6701-7 |
| 607320 | 11B-OH-Androsterone Z-score | 95584-9 |
| 607321 | 11B-OH-Etiocholanolone | 6700-9 |
| 607322 | 11B-OH-Etiocholanolone Z-score | 95585-6 |
| 607323 | Cortisone | 14044-2 |
| 607324 | Cortisone Z-score | 95586-4 |
| 607325 | Tetrahydrocortisone | 16116-6 |
| 607326 | Tetrahydrocortisone Z-score | 95587-2 |
| 607327 | a-Cortolone | 55906-2 |
| 607328 | a-Cortolone Z-score | 95588-0 |
| 607329 | B-Cortolone | 95589-8 |
| 607330 | B-Cortolone Z-score | 95590-6 |
| 607331 | 11-Oxoetiocholanolone | 6703-3 |
| 607332 | 11-Oxoetiocholanolone Z-score | 95591-4 |
Forms
Adrenal Mass Panel Patient Information is required if not ordering electronically.
Testing Algorithm
Testing begins with a clinical risk assessment based on clinical data before integration with biochemical steroid data to assess the probability of a malignant adrenal cortical carcinoma (ACC) or other malignancy (sarcoma, lymphoma, other) as well as the probability of a benign mass (adenoma, myelolipoma, cyst, other).
Clinical data includes age at diagnosis, gender, mode of discovery and hormonal status along with tumor diameter and an unenhanced computerized tomography (CT) scan density measurement of the tumor (in Hounsfield units).
Steroids and their metabolites are extracted, analyzed, quantitated, and reported. Each reported analyte also includes a Z-score. An integrated risk assessment based on clinical data in combination with biochemical steroid data is reported to assess the probability of a malignant ACC or other malignancy as well as the probability of a benign mass.
For more information see Adrenal Mass Panel Clinical Data Definition of Malignancy Predictors.