What is the most appropriate advice to give to the surgical team about perioperative management?

A 58-year-old man was referred to the endocrine clinic after a CT scan of abdomen had shown a 4.5-cm left adrenal mass, with a Hounsfield unit measurement of 11 (consistent with high lipid content). He had a 10-year history of type 2 diabetes mellitus and was taking metformin. He was also taking atenolol for hypertension.

On examination at the clinic, his blood pressure was 162/94 mmHg. He was centrally obese with a body mass index of 27 kg/m2 (18C25).

Investigations:

serum potassium3.9 mmol/L (3.5C4.9)

plasma renin activity (after 30 min upright)1.0 pmol/mL/h (3.0C4.3)

plasma aldosterone (after 4 h upright)680 pmol/L (330C830)

overnight dexamethasone suppression test (after 1 mg dexamethasone):

serum cortisol164 nmol/L (<50)

24-h urinary free cortisol132 nmol (55C250)

24-h urinary catecholamines

(adrenaline and noradrenaline)normal

As the lesion was >4 cm in diameter, laparoscopic adrenalectomy was recommended.

What is the most appropriate advice to give to the surgical team about perioperative management?
A . give corticosteroid cover during and after surgery and reassess postoperatively
B . give preoperative ?-adrenergic receptor blockade in case the lesion is an occult phaeochromocytoma
C . measure cortisol and aldosterone 2 weeks postoperatively
D . no special precautions are required
E . short tetracosactide (Synacthen®) test 48 h postoperatively

View Answer

Answer: A