Adrenal Incidentaloma

Question 1

Adrenal masses discovered incidentally. Patient without signs of hormonal excess or obvious underlying malignancy:

Answer 1

Adrenal incidentaloma

Question 2

Primary or metastatic tumor, granulomatous disease, hemorrhage, or lymphoma, 21-hydroxylase deficiency:

Answer 2

Differential diagnosis

Question 3

Is a common benign tumor arising from the cortex of the adrenal gland:

Answer 3

Adrenal Cortical Adenoma

Question 4

Is not considered to have the potential for malignant transformation:

Answer 4

Adrenal Cortical Adenoma

Question 5

“Adrenal metastases may be found in as many as ____ of patients with known primary lesions”:

Answer 5

25%

Question 6

Frequently face the task of determining whether an adrenal mass is benign or malignant:

Answer 6

Radiologist

Question 7

Treatment for a hormonally active (functional) adrenal tumor:

Answer 7

Adrenalectomy

Question 8

Treatment for a Malignant Adrenal Tumor:

Answer 8

depends on the cell type, spread, and location of the primary tumor

Question 9

Surgical excision in nonfunctional adrenal cortical adenomas:

Answer 9

Not indicated, because they’re not premalignant

Question 10

Chromosomal and genetic abnormalities (genes coding for p53 and p57):

Answer 10

Etiology

Question 11

“In about _____ of all cases, abdominal computed tomography (CT) scans that are obtained for reasons other than the evaluation for possible adrenal neoplasm demonstrate an adrenal mass”:

Answer 11

1-5%

Question 12

“The autopsy prevalence for AIs is ____”:

Answer 12

2-9%

Question 13

The most important hormonally silent AI is:

Answer 13

Pheochromocytoma

Question 14

“Prevalence increases with age; <1% for patients <30 years and is ____ for patients >70 years”:

Answer 14

7%

Question 15

AI prevalence is higher in:

Answer 15

White people, old, obese, hypertensive and diabetic

Question 16

“Approximately _____ of AIs are nonfunctional (hormonally silent) and benign”:

Answer 16

85%

Question 17

Adrenal insufficiency should be the first consideration, especially with:

Answer 17

Bilateral adrenal incidentalomas

Question 18

Lab tests:

Answer 18

Urine-free and plasma-free metanephrines, Plasma aldosterone-to-renin ratio,
CRH test with 60-minute cortisol levels, 2-day low-dose dexamethasone suppression test, urinary free cortisol test, a urinary metanephrine–to–creatinine ratio, or a renin-to-aldosterone ratio

Question 19

If a hormonal excess is found:

Answer 19

surgical removal is usually indicated

Question 20

If no hormonal excess is found and the corticotropin test results were unremarkable:

Answer 20

fine-needle aspiration

Question 21

helps distinguish between adrenal and metastatic disease.

Answer 21

fine-needle aspiration

Question 22

is the fourth most common site of metastasis:

Answer 22

The adrenal gland

Question 23

High blood pressure, catechol symptoms, suggests:

Answer 23

Pheochromocytoma

Question 24

High blood pressure, low K+, low Plama renin activity, suggests:

Answer 24

Primary aldosteronism

Question 25

Virilization or feminization, suggests:

Answer 25

Adrenocortical carcinoma

Question 26

Cushing symptoms, suggests:

Answer 26

Cushing Synd.

Question 27

Is needed to diagnose subclinical Cushing syndrome:

Answer 27

1mg overnight dexamethasone suppression test

Question 28

“Assume all Adrenal incidentalomas have a ________ until proven otherwise”:

Answer 28

pheochromocytoma

Question 29

Paroxysmal hyperadrenergic symptoms, suggests:

Answer 29

Pheochromocytoma

Question 30

Usually identified by suppressed upright plasma renin levels and concomitant elevated plasma aldosterone levels:

Answer 30

Hyperaldosteronism

Question 31

“Benign adrenal cortical adenomas are commonly smaller than ___ in diameter”:

Answer 31

6cm