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)
Neurofibromatosis type 1	NF1 gene mutation analysis
Pheochromocytoma-paraganglioma syndrome	SDHB/SDHD gene mutation analysis