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"Incidentaloma" in a Middle-aged Woman

"Incidentaloma" in a Middle-aged Woman

A 45-year-old woman presents with multiple injuries she sustained during a skiing
accident. She has fractures of her right arm and 3 ribs, as well as numerous
contusions. An abdominal CT scan shows no hemorrhage or other traumarelated
findings; however, a 6.7-cm left adrenal mass is detected.

Before the accident, the patient was healthy. She has no significant medical
conditions; her only medications are vitamin supplements and an oral contraceptive.
She has no history of back pain or hematuria.

Body habitus is normal; no skin lesions or striae; no hirsutism. Heart rate
is 92 beats per minute; respiration rate, 16 breaths per minute; and blood pressure,
118/78 mm Hg. Heart and lungs are normal. Abdomen and flanks are
soft and nontender, without palpable masses.

Results of a hemogram, serum chemistry panel, and urinalysis are normal.

Which of the following is the optimal strategy for evaluation of the
adrenal mass?
A. Order a chest CT scan, measure serum cortisol level at 4 PM, and repeat
the abdominal imaging in 3 months.

B. Order a 1-mg dexamethasone suppression test, measurement of plasma
free metanephrines, and a surgical consultation.

C. Measure plasma renin and aldosterone levels, measure serum cortisol
level at 8 AM, and repeat abdominal imaging in 6 months.

D. Measure serum testosterone level, measure fasting plasma epinephrine
and norepinephrine levels, and order a surgical consultation.


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