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Test ID ACC Adrenal Mass Panel, 24 Hour, Urine

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 and 24-hour volume


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 5 mL Aliquot Tube (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.


Adrenal Mass Panel Patient Information is required if not ordering electronically.

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 (ACC)

-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.

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.

Method Name

Liquid Chromatography-Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)

Reporting Name

Adrenal Mass Panel, 24 Hr, U

Specimen Type


Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Frozen (preferred) 90 days
  Refrigerated  14 days

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 hour

Etiocholanolone: 133-23,272 mcg/24 hour

Dehydroepiandrosterone: <5-81,554 mcg/24 hour

16a-OH-Dehydroepiandrosterone: 13-29,945 mcg/24 hour

5-Pregnenetriol: 23-7,328 mcg/24 hour

5-Pregnenediol: 13-2,823 mcg/24 hour

Tetrahydro-11-Corticosterone: 8-1,961 mcg/24 hour

Tetrahydro-11-Deoxycorticosterone: <5-316 mcg/24 hour

Pregnanediol: 12-3,812 mcg/24 hour

17a-OH-Pregnanolone: 15-2,466 mcg/24 hour

Pregnanetriol: 66-9,409 mcg/24 hour

Pregnanetriolone: <5-550 mcg/24 hour

Tetrahydrodeoxycortisol: 7-1520 mcg/24 hour

Cortisol: <5-903 mcg/24 hour

6B-OH-Cortisol: 13-2,303 mcg/24 hour

Tetrahydrocortisol: 152-22,723 mcg/24 hour

5a-Tetrahydrocortisol: 157-24,059 mcg/24 hour

B-Cortol: 30-5,115 mcg/24 hour

11B-OH-Androsterone: 108-11,987 mcg/24 hour

11B-OH-Etiocholanolone: 22-8,312 mcg/24 hour

Cortisone: 12-842 mcg/24 hour

Tetrahydrocortisone: 271-44,355 mcg/24 hour

a-Cortolone: 140-14,885 mcg/24 hour

B-Cortolone: 72-9,740 mcg/24 hour

11-Oxoetiocholanolone: 70-8,446 mcg/24 hour


Males ≥50 years:

Androsterone: 118-25,389 mcg/24 hour

Etiocholanolone: 127-15,640 mcg/24 hour

Dehydroepiandrosterone: 7-4,260 mcg/24 hour

16a-OH-Dehydroepiandrosterone: 11-6,183 mcg/24 hour

5-Pregnenetriol: 24-2,162 mcg/24 hour

5-Pregnenediol: 17-1,296 mcg/24 hour

Tetrahydro-11-Corticosterone: 16-1,674 mcg/24 hour

Tetrahydro-11-Deoxycorticosterone: <5-297 mcg/24 hour

Pregnanediol: 23-1,846 mcg/24 hour

17a-OH-Pregnanolone: 18-1,747 mcg/24 hour

Pregnanetriol: 115-5,432 mcg/24 hour

Pregnanetriolone: 5-221 mcg/24 hour

Tetrahydrodeoxycortisol: 12-1,277 mcg/24 hour

Cortisol: 12-597 mcg/24 hour

6B-OH-Cortisol: 22-2,406 mcg/24 hour

Tetrahydrocortisol: 331-19,009 mcg/24 hour

5a-Tetrahydrocortisol: 155-35,266 mcg/24 hour

B-Cortol: 56-3,541 mcg/24 hour

11B-OH-Androsterone: 142-13,135 mcg/24 hour

11B-OH-Etiocholanolone: 69-6,805 mcg/24 hour

Cortisone: 24-732 mcg/24 hour

Tetrahydrocortisone: 454-34,576 mcg/24 hour

a-Cortolone: 211-17,591 mcg/24 hour

B-Cortolone: 114-8,434 mcg/24 hour

11-Oxoetiocholanolone: 155-7,174 mcg/24 hour


Females 18-49 years:

Androsterone: 90-29,625 mcg/24 hour

Etiocholanolone: 127-24,568 mcg/24 hour

Dehydroepiandrosterone: <5-12,317 mcg/24 hour

16a-OH-Dehydroepiandrosterone: 5-31,248 mcg/24 hour

5-Pregnenetriol: 17-4,166 mcg/24 hour

5-Pregnenediol: 6-2,900 mcg/24 hour

Tetrahydro-11-Corticosterone: 13-1,548 mcg/24 hour

Tetrahydro-11-Deoxycorticosterone: <5-833 mcg/24 hour

Pregnanediol: 8-44,760 mcg/24 hour

17a-OH-Pregnanolone: 7-3,208 mcg/24 hour

Pregnanetriol: 50-9,768 mcg/24 hour

Pregnanetriolone: <5-139 mcg/24 hour

Tetrahydrodeoxycortisol: 7-1,047 mcg/24 hour

Cortisol: 11-642 mcg/24 hour

6B-OH-Cortisol: 22-2,061 mcg/24 hour

Tetrahydrocortisol: 185-16,515 mcg/24 hour

5a-Tetrahydrocortisol: 45-22,591 mcg/24 hour

B-Cortol: 28-4260 mcg/24 hour

11B-OH-Androsterone: 59-12,462 mcg/24 hour

11B-OH-Etiocholanolone: 32-6,354 mcg/24 hour

Cortisone: 19-749 mcg/24 hour

Tetrahydrocortisone: 262-32,461 mcg/24 hour

a-Cortolone: 207-13,931 mcg/24 hour

B-Cortolone: 63-7,489 mcg/24 hour

11-Oxoetiocholanolone: 63-7,449 mcg/24 hour


Females ≥50 years:

Androsterone: 32-10,134 mcg/24 hour

Etiocholanolone: 52-10,946 mcg/24 hour

Dehydroepiandrosterone: <5-10,046 mcg/24 hour

16a-OH-Dehydroepiandrosterone: <5-9,982 mcg/24 hour

5-Pregnenetriol: 10-1,901 mcg/24 hour

5-Pregnenediol: <5-2,732 mcg/24 hour

Tetrahydro-11-Corticosterone: 14-1,229 mcg/24 hour

Tetrahydro-11-Deoxycorticosterone: <5-123 mcg/24 hour

Pregnanediol: 8-2,138 mcg/24 hour

17a-OH-Pregnanolone: <5-571 mcg/24 hour

Pregnanetriol: 26-3,444 mcg/24 hour

Pregnanetriolone: <5-348 mcg/24 hour

Tetrahydrodeoxycortisol: 8-801 mcg/24 hour

Cortisol: 9-336 mcg/24 hour

6B-OH-Cortisol: 25-1,365 mcg/24 hour

Tetrahydrocortisol: 237-14,050 mcg/24 hour

5a-Tetrahydrocortisol: 92-12,604 mcg/24 hour

B-Cortol: 29-3289 mcg/24 hour

11B-OH-Androsterone: 86-9,280 mcg/24 hour

11B-OH-Etiocholanolone: 40-7,002 mcg/24 hour

Cortisone: 15-555 mcg/24 hour

Tetrahydrocortisone: 359-24,320 mcg/24 hour

a-Cortolone: 125-17,472 mcg/24 hour

B-Cortolone: 82-5,784 mcg/24 hour

11-Oxoetiocholanolone: 78-6,571 mcg/24 hour


Reference values have not been established for patients who are younger than 18 years of age.

Day(s) Performed


Report Available

7 to 17 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information


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 13362-9
VL66 Urine Volume 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

Urine Preservative Collection Options

Note: The application of temperature controls must occur within 4 hours of completion of the collection.








50% Acetic Acid


Boric Acid


Diazolidinyl Urea


6M Hydrochloric Acid


6M Nitric Acid


Sodium Carbonate