Bilateral Adrenal Incidentalomas: A Case Report and Review of Diagnostic Challenges
Table 1
Recommended screening tests in adrenal incidentalomas. Additional analyses in bilateral incidentalomas listed below will depend on the clinical presentation and family history.
Recommended screening for all incidentalomas
Test
Cushing’s syndrome
1 mg overnight dexamethasone suppression test
Pheochromocytoma
24-hour urine collection for fractionated metanephrines and catecholamines
Primary aldosteronism (screen only in hypertensive patients)
Plasma aldosterone to plasma renin activity ratio
Additional screening recommended for bilateral incidentalomas
Test
Adrenal insufficiency
Morning cortisol and ACTH (or corticotrophin stimulation test)
MEN2
RET gene mutation analysis, evaluation for hyperparathyroidism, medullary thyroid cancer, or mucosal neuromas
Von Hippel-Lindau syndrome
VHL gene mutation analysis and evaluation for additional tumors (such as renal, retinal, or nervous system)