Androgen-secreting adrenal tumour — SCE Endocrinology MCQ

Correct answer: D — Adrenal imaging with assessment of androgen and cortisol co-secretion

The best answer is “Adrenal imaging with assessment of androgen and cortisol co-secretion”. Rapid virilisation, predominant adrenal androgen excess and autonomous cortisol secretion raise concern for an adrenocortical neoplasm and require urgent anatomical staging and endocrine review. “Diagnose polycystic ovary syndrome and defer imaging for a year” is less appropriate because PCOS usually causes slower, milder androgen excess and does not explain cortisol autonomy “Start a combined oral contraceptive before localising the hormone source” is less appropriate because symptomatic treatment before localisation risks delaying a potentially malignant cause “Arrange pituitary MRI as the first localisation study” is less appropriate because the biochemical pattern points to adrenal rather than pituitary hormone production “Use a GnRH agonist trial as the definitive test for an adrenal tumour” is less appropriate because gonadal suppression does not replace direct imaging and staging of a suspected adrenal lesion

Reference: European Society of Endocrinology guideline on adrenal incidentalomas. https://academic.oup.com/ejendo/article/189/1/G1/7198474