eMedicine Specialties > Urology > Surgery

Adrenal Surgery: Workup

Author: Brian J Miles, MD, Medical Director, Chief of Urology Service, Director of Education, Associate Professor, Department of Urology, St Luke's Episcopal Hospital; Program Director, Baylor College of Medicine
Coauthor(s): Mohit Khera, MD, MBA, MPH, Assistant Professor of Urology, Scott Department of Urology, Baylor College of Medicine; Edward C Schatte, MD, Urologist, Adult and Pediatric Urology of Houston; John S Colen, MD, Resident Physician, Department of Urology, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Aug 20, 2009

Workup

Laboratory Studies

  • Serum
    • Electrolyte levels
    • Cortisol levels
    • Androgen levels
    • Free metanephrine levels (most sensitive test for pheochromocytoma)
  • Urine
    • 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.

Imaging Studies

  • CT scan has become the criterion standard. Other imaging studies often are used in conjunction with the CT scan in diagnosis of adrenal masses.
  • 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 an MIBG scan or 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

  • Blood pressure
  • Serum potassium levels (for aldosteronoma)

Diagnostic Procedures

Histologic Findings

A detailed discussion of the histologic findings is beyond the scope of this surgical article.

More on Adrenal Surgery

Overview: Adrenal Surgery
Workup: Adrenal Surgery
Treatment: Adrenal Surgery
Follow-up: Adrenal Surgery
References
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Further Reading

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Keywords

adrenal surgery, adrenal gland surgery, suprarenal surgery, Conn syndrome, Conn's syndrome, hyperaldosteronism, Cushing syndrome, Cushing's syndrome, pheochromocytoma, neuroblastoma, adrenocortical carcinoma, benign adenoma, primary hyperaldosteronism, partial adrenalectomy, bilateral adrenal hyperplasia, tumors of the adrenal cortex, multiple endocrine neoplasia, von Hippel-Lindau disease, von Recklinghausen disease, von Recklinghausen's disease, adrenal carcinoma, adrenal gland lesions, laparoscopic adrenalectomy, total adrenalectomy, radical adrenalectomy, laparoscopic partial adrenal resection, laparoscopic partial adrenalectomy, bilateral adrenal hyperplasia, ablation of adrenal masses, metastatic adrenocortical carcinoma

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Contributor Information and Disclosures

Author

Brian J Miles, MD, Medical Director, Chief of Urology Service, Director of Education, Associate Professor, Department of Urology, St Luke's Episcopal Hospital; Program Director, Baylor College of Medicine
Brian J Miles, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Association of Military Surgeons of the US, Society of Urologic Oncology, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mohit Khera, MD, MBA, MPH, Assistant Professor of Urology, Scott Department of Urology, Baylor College of Medicine
Mohit Khera, MD, MBA, MPH is a member of the following medical societies: American Medical Association, American Urological Association, and Texas Medical Association
Disclosure: Auxilium Honoraria Speaking and teaching; Coloplast Honoraria Speaking and teaching; American Medical Systems Honoraria Speaking and teaching

Edward C Schatte, MD, Urologist, Adult and Pediatric Urology of Houston
Edward C Schatte, MD is a member of the following medical societies: American Urological Association
Disclosure: Pfizer Consulting fee Speaking and teaching; Astellas Consulting fee Speaking and teaching; Glaxo Smith Kline Consulting fee Speaking and teaching; novartis Consulting fee Speaking and teaching

John S Colen, MD, Resident Physician, Department of Urology, Baylor College of Medicine
John S Colen, MD is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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