Endocrinology and diabetes: adrenal incidentaloma work-up: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology and diabetes: adrenal incidentaloma work-up

Sample item

A 55-year-old normotensive woman has a 3.5 cm right adrenal mass found incidentally on CT done for abdominal pain. Unenhanced attenuation is 35 Hounsfield units. Which test is essential before any biopsy or surgery?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Plasma free metanephrines

An adrenal mass that is not lipid-rich on unenhanced CT may be a phaeochromocytoma, and even normotensive patients can have silent tumours. Biopsy or surgery without blockade can precipitate a hypertensive crisis, so metanephrines are checked first. A dexamethasone suppression test is also done for cortisol excess.

Option by option

  • A. Short synacthen (ACTH) stimulation test

    The ACTH stimulation test assesses adrenal insufficiency.

  • B. Plasma free metanephrines (correct)

    Correct. Excluding phaeochromocytoma first avoids a catecholamine crisis.

  • C. Serum DHEA sulfate and testosterone

    DHEA sulfate helps to suspect androgen-secreting carcinoma but is not the essential pre-procedure test.

  • D. Adrenal venous sampling for lateralisation

    Adrenal vein sampling is used to lateralise primary aldosteronism, not for this screen.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Plasma free metanephrines. An adrenal mass that is not lipid-rich on unenhanced CT may be a phaeochromocytoma, and even normotensive patients can have silent tumours.

Why is "Short synacthen (ACTH) stimulation test" not the answer?

The ACTH stimulation test assesses adrenal insufficiency.

Why is "Serum DHEA sulfate and testosterone" not the answer?

DHEA sulfate helps to suspect androgen-secreting carcinoma but is not the essential pre-procedure test.

Why is "Adrenal venous sampling for lateralisation" not the answer?

Adrenal vein sampling is used to lateralise primary aldosteronism, not for this screen.

What concept does this question test?

It tests Endocrinology and diabetes: adrenal incidentaloma work-up in General Medicine. Biopsy or surgery without blockade can precipitate a hypertensive crisis, so metanephrines are checked first. A dexamethasone suppression test is also done for cortisol excess.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology and diabetes: adrenal incidentaloma work-up?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.