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Chapter 33. Adrenals

The most common approach to resect a 3-cm functioning adrenal tumor is via

A. Laparoscopy

B. Laparotomy

C. Flank incision

D. Posterior incision

E. Thoracoabdominal incision

A. Laparoscopy. Laparoscopic adrenalectomy is safe for small adrenal tumors. Large incisions are not necessary for most adrenal tumors and are associated with more morbidity.

The most sensitive and specific test for diagnosis of pheochromocytoma is

A. Plasma free catecholamines

B. 24-hour urinary VMA

C. 24-hour urinary catecholamines

D. Plasma free metanephrines

E. Plasma free VMA

A. 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 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. Obtain family history of adrenal disease

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

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 tumors can secrete the following, except

A. Normetanephrine

B. Aldosterone

C. Cortisol


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