Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

Adrenal Tumors 71

Signs & Symptoms

■Glucocorticoid excess: weight gain, central obesity, moon facies, pur-

ple striae, proximal muscle weakness, osteoporosis, menstrual irreg-

ularities, hypogonadism, hypertension, diabetes mellitus

■Mineralocorticoid excess: hypokalemia (spontaneous or easily pro-

voked), muscle cramps, muscle weakness, nocturia, polyuria, hyper-

tension, edema

■Androgen excess: hirsutism, menstrual irregularities, infertility,

acne, male pattern balding, breast atrophy

■Catecholamine excess: hypertension, paroxysms, headache, tachy-

cardia, increased sweating, orthostatic hypotension, constipation,

abdominal/chest pain

Routine Laboratory Test Findings

■Glucocorticoid excess: hypokalemia, alkalosis, hyperglycemia

■Mineralocorticoid excess: hypokalemia, alkalosis, mild hyperna-

tremia, anemia, hypomagnesemia

■Catecholamine excess: increased hematocrit; hyperglycemia

tests

Laboratory

■Cortisol excess (Cushing syndrome):

➣Basic:

1.0 mg overnight dexamethasone suppression test

24-h urine free cortisol (UFC)

■Confirmatory: 8 AM plasma ACTH level

■Mineralocorticoid excess:

➣Basic:

Plasma renin activity (PRA)

Serum aldosterone

Aldosterone/PRA ratio

➣Confirmatory:

24-h urine aldosterone and cortisol

18-OH corticosterone

Saline suppression test (serum aldosterone after 2L IV normal

saline)

Supine (8 AM) and standing (noon) aldosterone, 18-OH corti-

costerone, and PRA

■Androgen excess:

➣Serum testosterone, DHEA-S, androstenedione, prolactin, LH,

FSH