Adrenal Surgery

A 38-year-old woman from Delhi presents with a 6-month history of progressive hypertension (BP 170/105 mmHg), hypokalemia (K⁺ 2.8 mEq/L), and metabolic alkalosis (HCO₃⁻ 32 mEq/L). She denies headaches or palpitations. Plasma renin activity is suppressed (0.3 ng/mL/hr; normal 0.5–1.6), and plasma aldosterone is elevated at 28 ng/dL (normal <15). Abdominal CT shows a 1.2 cm left adrenal nodule with low attenuation (–5 HU). Adrenal vein sampling confirms a 4:1 aldosterone gradient (left:right). What is the most appropriate next step in management?

Which of the following is the most common functional adrenocortical tumor in adults?

A 52-year-old man from Mumbai presents with a 3-month history of severe headaches, profuse diaphoresis, and episodic palpitations. Blood pressure is 185/110 mmHg at rest, rising to 210/125 mmHg during a headache episode. Fasting plasma glucose is 156 mg/dL. Urine metanephrines are elevated at 450 μg/24 hr (normal <100). Plasma free metanephrines are 2.8 nmol/L (normal <0.9). CT abdomen shows a 3.5 cm right adrenal mass with heterogeneous enhancement and central necrosis. The patient is scheduled for right adrenalectomy in 2 weeks. Which preoperative pharmacological preparation is most critical to prevent intraoperative hypertensive crisis?

In adrenocortical carcinoma, which TNM staging criterion defines Stage III disease?

A 38-year-old woman presents with a 6-month history of progressive hypertension (BP 165/105 mmHg), unprovoked hypokalemia (K⁺ 2.8 mEq/L), and metabolic alkalosis (HCO₃⁻ 32 mEq/L). She denies headaches, palpitations, or diaphoresis. Plasma renin activity is suppressed (<0.5 ng/mL/hr), and plasma aldosterone is elevated at 28 ng/dL. Abdominal CT shows a 1.5 cm left adrenal nodule with low attenuation (–5 HU). What is the most appropriate next step in management?