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Aspirin for Primary Prevention — ABIM Board MCQ

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HardPreventive MedicineAspirin for Primary PreventionABIM Board

A 57-year-old woman has a 2.2-cm homogeneous adrenal incidentaloma with unenhanced attenuation 6 HU. She has hypertension and potassium 3.1 mEq/L. She has no overt Cushing features or episodic symptoms. Which hormonal evaluation is appropriate?

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Correct answer: B — Perform dexamethasone suppression and aldosterone-renin testing

The best answer is “Perform dexamethasone suppression and aldosterone-renin testing”. Benign imaging does not exclude hormone secretion. Adrenal incidentalomas require assessment for autonomous cortisol secretion, and hypertension with hypokalemia specifically indicates primary-aldosteronism screening. Pheochromocytoma testing may be omitted in a homogeneous lesion at or below 10 HU under contemporary algorithms, but cortisol and aldosterone evaluation remain necessary here.

Reference: American Association of Endocrine Surgeons Adrenalectomy Guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC9386598/