What is the most appropriate initial management of the adrenal lesion?

A 55-year-old woman presented complaining of difficulty losing weight.

On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.

An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland.

She was treated with ramipril and further endocrine evaluation was performed.

Investigations:

serum potassium3.6 mmol/L (3.5C4.9)

serum creatinine135 µmol/L (60C110)

plasma renin activity:

(after 30 min supine)3.9 pmol/mL/h (1.1C2.7)

(after 30 min upright)6.8 pmol/mL/h (3.0C4.3)

plasma aldosterone:

(after 30 min supine)150 pmol/L (135C400)

(after 4 h upright)350 pmol/L (330C830)

serum cortisol (09.00 h)650 nmol/L (200C700)

serum cortisol (22.00 h)225 nmol/L (50C250)

24-h urinary free cortisol230 nmol (55C250)

24-h urinary dopamine3200 nmol (<3100)

24-h urinary adrenaline120 nmol (<144)

24-h urinary noradrenaline450 nmol (<570)

What is the most appropriate initial management of the adrenal lesion?
A . ?-adrenoceptor blockade
B . angiotensin-2 receptor blockade
C . medical observation with annual ultrasonography
D . mineralocorticoid receptor blockade
E . surgical excision

View Answer

Answer: E