A 65-Year-Old Woman Comes to the Emergency Department Due to Abdominal

question 7

Multiple Choice

A 65-year-old woman comes to the emergency department due to abdominal pain.  The pain subsequently subsides, but a 3.5-cm left adrenal mass is seen on abdominal CT scan.  No other abnormalities are noted.  The mass appears rounded and vascular, and has a high attenuation (25 Hounsfield units) .  The patient has experienced no headaches, palpitations, mood swings, or recent weight gain.  Medical history is notable for hypertension that is well controlled with amlodipine.  She has a current 40-pack-year smoking history.  Family history is unremarkable.
Blood pressure is 138/90 mm Hg and pulse is 76/min.  BMI is 26 kg/m².
Fasting laboratory results are as follows:
Which of the following is the most appropriate next step in evaluating this patient?

• A)24-hour blood pressure monitoring
• B)CT-guided fine-needle aspiration of the adrenal mass
• C)CT scan of the chest to rule out malignancy
• D)Follow-up CT scan of the abdomen in 6 months
• E)Testing for adrenal hormonal hypersecretion

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