Adrenal Surgery Workup

Updated: Aug 12, 2016
  • Author: Brian J Miles, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Workup

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

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  • 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

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  • Blood pressure

  • Serum potassium levels (for aldosteronoma)

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Diagnostic Procedures

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  • 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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