Endocrinology Question 25 Instructor

How do you investigate the patient with an adrenal incidentaloma?

Potential concerning issue Problem if:
  • Size >4cm
  • CT characteristics not consistent with adenoma
  • Known primary malignancy
  • Virilization with DHEAS
  • 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
  • Only screen if patient is hypertensive or hypokalemic
  • Screen for aldosterone/renin ratio, aldosterone

Subscribe to Pearls

Uncle Sam wants you to subscribe to Medical Pearls

Subscribe today! It’s always free, and you can easily unsubscribe at any time. We will never share your email address. Subscribe to...

Multiple Pearls
Cardiology Pearls
Endocrinology Pearls
Hematology Pearls
Nephrology Pearls
Rheumatology Pearls
Transplant Pearls
General Internal Medicine Pearls
Instructor Pearls

Subscribe to receive your pearls today—it's free!