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NEW QUESTION: 1
A 58-year-old man was referred to the endocrine clinic after a CT scan of abdomen had shown a 4.5-cm left adrenal mass, with a Hounsfield unit measurement of 11 (consistent with high lipid content). He had a 10-year history of type 2 diabetes mellitus and was taking metformin. He was also taking atenolol for hypertension.
On examination at the clinic, his blood pressure was 162/94 mmHg. He was centrally obese with a body mass index of 27 kg/m2 (18-25).
serum potassium3.9 mmol/L (3.5-4.9)
plasma renin activity (after 30 min upright)1.0 pmol/mL/h (3.0-4.3)
plasma aldosterone (after 4 h upright)680 pmol/L (330-830)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol164 nmol/L (<50)
24-h urinary free cortisol132 nmol (55-250)
24-h urinary catecholamines
(adrenaline and noradrenaline)normal
As the lesion was >4 cm in diameter, laparoscopic adrenalectomy was recommended.
What is the most appropriate advice to give to the surgical team about perioperative
A. give corticosteroid cover during and after surgery and reassess postoperatively
B. measure cortisol and aldosterone 2 weeks postoperatively
C. give preoperative ?-adrenergic receptor blockade in case the lesion is an occult phaeochromocytoma
D. short tetracosactide ([email protected]) test 48 h postoperatively
E. no special precautions are required
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