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
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.