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Adrenal incidentaloma with primary aldosteronism suspicion — SCE Endocrinology MCQ

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HardAdrenalAdrenal incidentaloma with primary aldosteronism suspicionSCE Endocrinology

A 43-year-old man is found to have a 3.4 cm left adrenal mass on CT for renal colic. Blood pressure is 168/94 mmHg and potassium is 3.1 mmol/L. Non-contrast attenuation is 7 HU. What is the most appropriate next investigation?

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Correct answer: E — Aldosterone-renin ratio after correcting potassium and reviewing interfering drugs

Aldosterone-renin ratio after correcting potassium and reviewing interfering drugs is best because hypertension and hypokalaemia in an adrenal incidentaloma should prompt screening for primary aldosteronism. The alternatives are less appropriate because benign imaging does not exclude function; surgery needs biochemical work-up; water deprivation tests diabetes insipidus; isolated DHEAS is not the key screen. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions