Adrenal Disorders USMLE Step 1 Practice Question
A 52-year-old man with a 10-year history of hypertension presents to the emergency department with a 2-hour history of sudden-onset severe occipital headache, diaphoresis, and tremor. His wife reports he has been increasingly anxious over the past month. Vital signs: BP 215/125 mmHg, HR 122/min, RR 22/min, temperature 37.1°C. Physical examination is notable for diaphoresis and mild tremor but no focal neurologic deficits. A stat non-contrast head CT is normal. Laboratory studies show serum glucose 278 mg/dL and serum creatinine 1.2 mg/dL. Twenty-four-hour urine metanephrines are elevated at 2.9 nmol/L (normal <0.9 nmol/L). Abdominal CT with contrast reveals a 3.2-cm right adrenal mass with homogeneous enhancement and no imaging features concerning for malignancy. Which of the following is the most appropriate next step in management?
Answer choices
- AProceed directly to right adrenalectomy after acute blood pressure stabilization
- BInitiate intravenous nicardipine for hypertensive emergency, then obtain plasma free metanephrines before further intervention
- CStart phenoxybenzamine for alpha-blockade, then add a beta-blocker after adequate alpha-blockade is achievedCorrect answer
- DAdminister intravenous labetalol to rapidly reduce blood pressure, then schedule adrenalectomy within 24 hours
- EPerform fine-needle aspiration biopsy of the adrenal mass to confirm pheochromocytoma before surgical planning
- FStart prazosin and arrange outpatient follow-up with cardiology for further blood pressure management
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