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Adrenal Incidentaloma — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesAdrenal IncidentalomaRACP Adult Medicine

A 55-year-old man is found to have a 2.8 cm right adrenal incidentaloma on CT performed for abdominal pain. His blood pressure is normal. What biochemical investigations should be performed?

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Correct answer: C — Plasma metanephrines and overnight dexamethasone suppression test

All adrenal incidentalomas require biochemical workup to exclude phaeochromocytoma (plasma free metanephrines – most sensitive test), subclinical Cushing's syndrome (1 mg overnight dexamethasone suppression test), and primary aldosteronism if hypertensive (aldosterone/renin ratio). This applies regardless of size. Imaging characteristics and size guide decisions about surgical referral.

Reference: eTG – 2025 – Endocrinology; ESE/ENSAT – 2016 – Adrenal Incidentaloma Guidelines