Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of an adrenal incidentaloma identified on recent cross-sectional imaging (CT/MRI). Patient denies symptoms suggestive of catecholamine excess (paroxysmal palpitations, diaphoresis, headaches), hypercortisolism (weight gain, proximal muscle weakness, striae), or mineralocorticoid excess (hypertension, muscle cramps). No history of malignancy or constitutional symptoms.
Clinical Examination Findings
General: Patient is in no acute distress. Vitals: BP [___] mmHg, HR [___] bpm. Abdomen: Soft, non-tender, non-distended. No palpable masses. Skin: No striae, bruising, or hyperpigmentation. Neurological: No focal deficits.
Treatment Protocol
Plan: 1. Biochemical workup: 24-hour urine metanephrines, 1mg overnight dexamethasone suppression test, and plasma aldosterone/renin ratio. 2. Imaging: Review of Hounsfield units (HU) and washout characteristics. 3. Surgical consultation if functional, size >4cm, or suspicious radiological features. 4. Follow-up imaging in 6-12 months if non-functional and <4cm.