Adrenal Disorders USMLE Step 1 Practice Question
A 52-year-old man with hypertension controlled on a single antihypertensive agent presents for a routine CT abdomen for evaluation of flank pain. Imaging reveals a 2.3-cm left adrenal mass with benign imaging characteristics (high lipid content, homogeneous appearance, no contrast washout delay). Laboratory evaluation shows: ACTH-stimulated cortisol 18 mcg/dL (normal), plasma renin activity 1.2 ng/mL/hr (normal), aldosterone 8 ng/dL (normal), and plasma free metanephrines 45 pg/mL (normal). The patient is asymptomatic with no signs of hormonal excess. Which of the following is the most appropriate next step in management?
Answer choices
- ARepeat CT imaging of the adrenal glands in 12 months, then annually for 2 years if stableCorrect answer
- BPerform adrenalectomy given the patient's age and to reduce long-term cancer risk
- CObtain a dedicated adrenal MRI with diffusion-weighted imaging to better characterize the lesion
- DMeasure 24-hour urinary free cortisol and DHEA-sulfate to screen for autonomous cortisol secretion
- EProceed with fine-needle aspiration biopsy under ultrasound guidance to exclude adrenocortical carcinoma
- FInitiate mitotane therapy to prevent potential malignant transformation of the adenoma
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