Flashcards in Assessment of incidental adrenal mass Deck (12):
Most common tumor in adults
10% adrenocortical Ca
Common-> non-secreting adrenal adenoma
Adrenal cyst, myelolipomas, hemangiomas, ganglioneuroma
Adrenal malignant melanoma
Clinical signs of hormone overproduction
Mass effect->abdominal pain
Features of primary hyperaldosteronism
Hypokalemia induced nephrogenic diabetes insipidus
Electrolytes: hypokalaemia may suggest hyperaldosteronism; hypokalaemia may be present in Cushing's syndrome.
Fasting lipid profile: hyperlipidaemia may be present in Cushing's syndrome.
Fasting blood glucose: hyperglycaemia may be present in Cushing's syndrome or phaeochromocytoma.
FBC: leukocytosis with neutrophilia may occur in Cushing's syndrome.
Screening test for Cushing's syndrome with late night salivary cortisol or overnight (1 mg) dexamethasone suppression test (OST).
Screening for phaeochromocytoma with fractionated plasma metanephrines.
Patients with HTN should also have plasma renin/aldosterone ratio measured to assess for hyperaldosteronism.
If screening for hormone activity positive, further testing
For Cushing's syndrome, 24-hour urine free cortisol and early morning (9 am) serum corticotropin (ACTH).
For phaeochromocytoma, 24-hour urine total metanephrines and fractionated catecholamines.
For hyperaldosteronism, plasma aldosterone concentration on an unrestricted salt diet, 24-hour urinary aldosterone excretion, and saline infusion test (saline suppression test
CT with contrast and MRI
Features of benign on imaging
Features of malignancy on imaging
>20HU on unenhanced CT
Delay in contrast medium washout
Imaging evaluation at 6-12 months
Biochemical testing annually