1️⃣ Focused History: You have 3 minutes to understand if the mass is functionally active. Think of the adrenal gland’s three layers. Ask about:
Inner Layer (Medulla): Headaches, palpitations, excessive sweating—possible pheochromocytoma?
Middle Layer (Cortex): Unusual weight gain, bruising—maybe Cushing’s syndrome?
Outer Layer: Muscle weakness, cramping, high BP—hyperaldosteronism?
2️⃣ Differentials & Management:
Could be benign (common) or something more serious like pheochromocytoma or carcinoma.
Management depends on whether the mass is causing symptoms, its size, and biochemical test results:
Asymptomatic Patients:
Negative Biochemical Results: If the mass is <4 cm, follow-up imaging is recommended. If >4 cm, consider referral to a specialist for further evaluation, particularly if there are any suspicious features.
Positive Biochemical Results: Referral to a specialist is needed. If the patient is <40 years, surgical removal is often considered. For patients >40 years, medical management may be considered if they are not suitable candidates for surgery.
Symptomatic Patients:
Positive Biochemical Results: Referral for surgical removal of the adrenal mass is typically recommended, regardless of age, especially if symptoms are significant.
Negative Biochemical Results: Management depends on the size and nature of the symptoms. If <4 cm, follow-up is advised, but if >4 cm, further evaluation and possible intervention may be needed.
3️⃣ Key to Pass:
Ask relevant questions and reassure the patient—most adrenal masses are benign.
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