Endocrinology Question 25 Instructor

How do you investigate the patient with an adrenal incidentaloma?

Potential concerning issue	Problem if:
Malignancy	Size >4cm CT characteristics not consistent with adenoma Known primary malignancy Virilization with DHEAS
Pheochromocytoma	Symptoms of triad: pain (headache), palpitations, perspiration Hypertension: 50% will have intermittent 24h urine collection: creatinine, metanephrines, and/or catecholamines
Cushing’s syndrome (can be subclinical)	Symptoms and signs 1mg dexamethasone suppression test: Drug is taken between 11PM and midnight Measure cortisol at 8AM following morning >50 nmol/L is abnormal
Hyperaldosteronism	Only screen if patient is hypertensive or hypokalemic Screen for aldosterone/renin ratio, aldosterone

Subscribe to Pearls