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Chapter 35. Adrenals

The most sensitive and specific test for diagnosis of pheochromocytoma is

A. Plasma free catecholamines

B. 24-hour urinary vanillylmandelic acid (VMA)

C. 24-hour urinary catecholamines

D. Plasma free metanephrines

E. Plasma free VMA

The correct answer is D. Plasma free metanephrines. Plasma free metanephrines or 24-hour urinary fractionated metanephrines are the most sensitive and specific test for diagnosis of pheochromocytoma/paraganglioma.

The workup of an adrenal incidentaloma includes all of the following, except

A. Measurement of 24-hour urinary fractionated metanephrines

B. Measurement of 24-hour urinary cortisol and creatinine

C. Fine-needle biopsy of the adrenal tumor

D. Plasma aldosterone level and renin activity

E. Obtaining family history of adrenal disease

The correct answer is C. Fine-needle biopsy of the adrenal tumor. Fine-needle biopsy of an adrenal tumor is almost never necessary, is associated with significant false positive and false negative results, can be dangerous (for pheochromocytoma) and risks seeding of tumor (adrenocortical cancer).

Laparoscopic adrenalectomy is usually not indicated for

A. An aldosteronoma

B. A feminizing tumor

C. A pheochromocytoma

D. A metastasis from melanoma

E. A symptomatic myelolipoma

The correct answer is B. A feminizing tumor. Feminizing adrenal tumors are rare, large, and almost always adrenal cortical cancer. Laparoscopic resection would be both difficult and risk local recurrence and seeding of the cancer. In contrast, metastatic cancer to the adrenal gland can usually be resected safely by laparoscopy.

Adrenal tumor can secrete all of the following, except

A. Normetanephrine

B. Aldosterone

C. Cortisol



The correct answer is E. 5-HIAA. Adrenal tumors do not secret 5-HIAA as do some carcinoid tumors.

All of the following are true about the perioperative care of a patient undergoing unilateral adrenalectomy for pheochromocytoma, except


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