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Adrenal incidentaloma — SCE Endocrinology MCQ

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EasyAdrenalAdrenal incidentalomaSCE Endocrinology

A 56-year-old woman has a 2 cm adrenal incidentaloma. She has paroxysmal hypertension and panic-like episodes. Non-contrast CT attenuation is 28 HU. What is the most appropriate biochemical test?

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Correct answer: A — Plasma free or urinary fractionated metanephrines

Symptoms plus lipid-poor adrenal lesion require exclusion of phaeochromocytoma using metanephrines. A short synacthen test assesses adrenal reserve, not catecholamine excess. Missing phaeochromocytoma before biopsy or surgery is dangerous.

Reference: European Society of Endocrinology Adrenal Incidentaloma Guideline