A follow-up CT scan in a 60-year-old patient with previous nephrolithiasis reveals a 1.5-cm hypovascular round lesion with clear margins in the right adrenal gland. The patient is not hypertensive, hyperglycemic, or hypokalemic. Urinary catechol metabolites are within normal limits, and serum cortisol and ACTH levels are normal. Which course is advisable?
The adrenal "incidentaloma" is an increasingly common finding with the ubiquitous use of CT scanning, with an incidence of 0.4 to 4.4%. A variety of benign and malignant lesions can account for these findings, and a distant history of malignancy elsewhere should raise the possibility of metastatic disease. Primary malignancy of the adrenal gland is rare, and the functioning tumors are excluded by screening tests for cortisol and catecholamine excess. In the absence of symptoms associated with adrenally disease, annual follow-up of these lesions with imaging and chemical tests seems prudent.
Advantages of laparoscopic adrenalectomy compared with open adrenalectomy include all of the following EXCEPT:
Laparoscopic (videoscopic) approaches to adrenalectomy have been shown to be advantageous for several outcomes including wound complications, analgesic use, and length of hospital stay. These advantages are in balance to adverse considerations including length of operative time and cost.
In patients who undergo bilateral adrenalectomy in treatment of Cushing disease after failed attempts at resection of an ACTH-secreting pituitary adenoma, the subsequent development of Nelson syndrome is associated with all of the following EXCEPT:
Nelson syndrome describes symptoms due to the progressive enlargement of a persistent ACTH -secreting pituitary fossa tumor. These symptoms include hyperpigmentation, visual field loss, headaches, and extraocular muscle palsies. Interference with the olfactory nerve is not part of the syndrome.
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