Endocrinology

Answer 1 24-Hour urine collection for metanephrines. This is a case of an “incidentaloma,” a mass found in imaging studies performed for other reasons. Patients usually have no symptoms related to the mass. The majority of these tumors are nonfunctioning, but a work-up is mandatory to ensure that no hormonal dysfunction exists. The usual tests ordered are (1) a 24-hour urine collection for free cortisol to rule out Cushing’s syndrome, (2) a 24-hour urine collection for metanephrines and catecholamines to rule out pheochromocytoma, and (3) depending on the existence of hypertension and electrolytic problems, blood levels of aldosterone and renin to rule out primary hyperaldosteronism.1 REFERENCE 1. Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 2003;138:424-9. Click here to return to the questions

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