Hepcidin concentration and effect on iron homeostasis in patients with adrenocortical carcinoma and benign adrenal lesions - a pilot study.

PURPOSE: The evaluation of hepcidin concentration and iron (Fe) homeostasis parameters in patients with: adrenocortical carcinoma (ACC) to compared to control subjects (CS) and in ACC patients before surgical or pharmacological treatment (ACC-nt) to ACC patients during mitotane therapy (ACC-t). METHODS: We enrolled 33 adult patients with histopathologically confirmed non-adenoma of adrenal gland. Each patient underwent hepcidin, Fe metabolism parameters and biochemical evaluation. Hepcidin levels were measured using the Hepcidin 25 (bioactive) hs ELISA, a highly sensitive enzyme immunoassay designed for the quantitative in vitro diagnostic determination (DRG Instruments GmbH, Germany). The study group was consisted of: 13 patients (10 females) with ACC following adrenal surgery undergoing mitotane therapy (ACC-t), 9 patients (6 females) with ACC who had not received prior pharmacological or surgical treatment (ACC-nt) and 11 patients (6 females) with histologically benign adrenal tumors who underwent subsequent surgery (CS). RESULTS: The patients with ACC present higher median values of hepcidin compared to CS: [13.9 (7.6–24.3) vs. 12.3 (1.5–20.9) ng/mL, p > 0.052], while in ACC-nt group was lower than in ACC-t [11.1 (8.3–24.3) vs. 14.9 (7.6–24.3) ng/mL, p = 0.053]. We noticed statistically significant differences between ACC and CS group: RBC-m, HGB, MCH, MCHC, Fe-m concentration and correlations between: hepcidinACC vs. ferritin-maleACC, hepcidinACC vs. ferritin-femaleACC, hepcidinACC−nt vs. ferritin-maleACC−nt, hepcidinACC−nt vs. ferritin-femaleACC−nt, hepcidinCS vs. ferritin-femaleCS and hepcidinCS vs. MCVCS. CONCLUSIONS: In patients with ACC the neoplastic process increases hepcidin level, which leads to decreased hematological parameters, while treatment improve Fe homeostasis.