Adrenal Surgery Workup

Updated: May 14, 2021
  • Author: Brian J Miles, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Workup

Laboratory Studies

Serum laboratory studies include the following:

  • Electrolyte levels

  • Cortisol levels

  • Androgen levels

  • Free metanephrine levels (most sensitive test for pheochromocytoma)

Urine studies that may be included in the evaluation are as follows:

  • 24-hour catecholamine levels

  • 24-hour metanephrine levels (most specific test for pheochromocytoma)

  • 24-hour free cortisol levels

  • 17-ketosteroids and 17-hydroxycorticosteroids levels

If a pheochromocytoma is suspected, a clonidine suppression test or glucagon stimulation test can be performed to confirm the diagnosis.

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Imaging Studies and Other Tests

Imaging studies

Computed tomography (CT) has become the criterion standard. Other imaging studies often are used in conjunction with the CT scan in the diagnosis of adrenal masses.

Magnetic resonance imaging (MRI) frequently is useful in delineating lesions. In the case of adrenocortical carcinoma, regardless of size or function, if T2-weighted images from an MRI reveal a high-intensity signal, this finding is strongly suggestive of a malignancy, and exploration is warranted.

Nuclear scans such as a metaiodobenzylguanidine (MIBG) scan or an iodine-131-beta-iodomethyl-norcholesterol (NP-59) scan can also help delineate between malignant and benign lesions. An MIBG scan may be helpful with pheochromocytomas because MIBG is taken up in the norepinephrine pathway and suggests function. NP-59 is taken up by the adrenal cortex and by adenomas. Space-occupying lesions, such as adrenocortical carcinoma, do not take up the tracer.

Other tests

Other tests that may be used in the workup include the following:

  • Blood pressure

  • Serum potassium levels (for aldosteronoma)

 

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