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Adrenal Surgery Workup

  • Author: Brian J Miles, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Dec 24, 2014
 

Laboratory Studies

See the list below:

  • 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.
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Imaging Studies

See the list below:

  • 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.
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Other Tests

See the list below:

  • Blood pressure
  • Serum potassium levels (for aldosteronoma)
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Diagnostic Procedures

See the list below:

  • See Surgical therapy.
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Histologic Findings

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

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Contributor Information and Disclosures
Author

Brian J Miles, MD, FACS Medical Director of Robotic Surgery, Houston Methodist Hospital; Clinical Professor, Department of Urology, Baylor College of Medicine; Professor of Urology, Weill Cornell Medical College

Brian J Miles, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Gene and Cell Therapy, American Society of Clinical Oncology, Societe Internationale d'Urologie (International Society of Urology), Harris County Medical Society, Society of Government Service Urologists, Washington Urologic Society, Society of University Urologists, American Medical Association, American Urological Association, Association of Military Surgeons of the US, Society of Urologic Oncology, Texas Medical Association, Texas Urological Society

Disclosure: Nothing to disclose.

Coauthor(s)

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: Received consulting fee from Pfizer for speaking and teaching; Received consulting fee from Astellas for speaking and teaching; Received consulting fee from Glaxo Smith Kline for speaking and teaching; Received consulting fee from novartis for speaking and teaching; Received consulting fee from Watson for speaking and teaching.

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, Texas Medical Association

Disclosure: Received honoraria from Auxilium for speaking and teaching; Received honoraria from Coloplast for speaking and teaching; Received honoraria from American Medical Systems for 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

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Magnetic resonance imaging (MRI) scan in a patient with Conn syndrome showing a left adrenal adenoma.
Homogeneous, well-defined, 7-HU ovoid mass is seen in the right adrenal gland; this finding is diagnostic of a benign adrenal adenoma.
Table. TNM Staging System for Neoplastic Lesions of the Adrenal Gland
StageTNM
Stage IT1, N0, M0
Stage IIT2, N0, M0
Stage IIIT3, N0, M0 or T1-2, N1, M0
Stage IVAny T, N, M1, or T3-4, N1, M0
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