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Adrenal incidentaloma — SCE Endocrinology MCQ

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HardAdrenalAdrenal incidentalomaSCE Endocrinology

A 64-year-old woman has an incidental 4.7 cm adrenal lesion with unenhanced CT attenuation of 28 HU. She has hypertension and a 1 mg overnight dexamethasone cortisol of 96 nmol/L. Plasma metanephrines are pending. What is the most appropriate management?

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Correct answer: D — Refer to adrenal MDT for malignancy-risk and hormone-excess assessment

Size above 4 cm, high attenuation and possible autonomous cortisol secretion require specialist adrenal MDT assessment. Biopsy is not done before excluding phaeochromocytoma and rarely helps primary adrenal malignancy assessment. The pearl is that incidental does not mean insignificant.

Reference: European Society of Endocrinology adrenal incidentaloma guideline