A 56-Year-Old Woman Comes to the Physician for Evaluation of a Right

question 369

Multiple Choice

A 56-year-old woman comes to the physician for evaluation of a right adrenal mass found 2 weeks ago on an abdominal CT scan performed for renal colic.  The lesion is 2 cm in diameter, round, and has low x-ray attenuation (8 Hounsfield units) on non-contrast slices.  Her other medical problems include hypertension treated with amlodipine.  Family history is unremarkable.
Her blood pressure is 144/96 mm Hg, pulse is 66/min, and BMI is 26 kg/m².  The remainder of the examination is within normal limits.
Laboratory results are as follows:

Which of the following is the most appropriate next step in managing this patient?

• A)Add hydrochlorothiazide and follow-up in 4 weeks
• B)Aldosterone to renin ratio
• C)Fine needle aspiration of the mass
• D)Repeat CT scan of the abdomen in 6 months
• E)Unilateral laparoscopic right adrenalectomy

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