September 24, 2017
Biochemical Investigation of an Adrenal Incidentaloma Minimize

Biochemical investigation of an adrenal incidentaloma

Indication

The presence of adrenal incidentalomas has been shown in autopsy studies to occur in about 6% cases and this is mirrored by CT series (Young 2007). The majority of these tumours are silent and express subtle forms of hypercortisolism. However, since most adrenal nodule morbidity is related to hormonal hypersecretion or malignancy, a degree of evaluation is necessary to ascertain if there is:

  1. unsuspected overt hormonal hypersecretion or
  2. to identify subtle hormonal hypersecretion,
  3. to exclude primary or secondary adrenal malignancy (imaging and/or fine needle biopsy).

Contraindication

Principle

  1. Screening tests for cortisol hypersecretion by 24 h UFC and low dose dexamethasone suppression test.
  2. Screening for phaeochromocytoma
  3. Screening for hyperaldosteronism
  4. Screening for excess androgen secretion

Side effects

Preparation

No patient preparation is required

Requirements

  1. 2 x 24 hour urine containers (acidified for catecholamines and plain for cortisol)
  2. 1 mg dexamethasone
  3. 1 plain blood tube (for cortisol)
  4. 2 Li heparin blood tube (for renin-aldosterone, testosterone & DHEAS)

Procedure

Day 1:

24 hour urine collection for cortisol (plain container)
during the day take a random blood sample for:
- plasma renin activity and aldosterone in Li heparin tube (5 mL) Do not collect on ice.
- testosterone and DHEAS

Day 2:

24 hour urine collection for catecholamines (acidified container)

Day 3:

The patient takes 1 mg Dexamethasone orally between 2200-2400 and the following morning at 0900h a blood sample (3 mL plain blood) is taken for plasma cortisol.

Interpretation

See individual tests

Sensitivity and Specificity

See individual tests

References

  • Osella G, Terzolo M, Borretta G, Magro G, Ali A, Piovesan A, Paccotti P, Angeli A. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J Clin Endocrinol Metab 1994;79:1532-1539.
  • Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A. Management of adrenal incidentaloma. Best Prac Res Clin Endocrinol Metab 2009;23:233-243.
  • Tsagarakis A. The management of adrenal incidentalomas. In: Grossman A (ed). Clinical Endocrinology. Blackwells Science, Oxford. 2nd edit 1998:484-493.
  • Young WF Jr. The Incidentally Discovered Adrenal Mass. NEJM 2007;356:601-610.

JHB 20 Aug 2009

  

Home|Paediatric|Endocrinology|Renal & electrolytes|Metabolic|Investigation protocols|Misc
Comments about this site to julian.barth@nhs.net Terms Of Use Privacy Statement