A 42-year-old woman presents for evaluation of a 2.8-cm left adrenal mass. She was seen in the emergency department 1 week ago for abdominal pain. CT scan shows only the adrenal mass. Physical examination, vital signs, and review of systems are all normal. Medical history and family history are unremarkable.
What is the first step in management of this patient?
A. Reassure the patient and suggest follow-up CT scan in 6 months
B. Arrange CT-guided needle biopsy of the mass
C. Order a plasma and urine hormone work-up
D. Consult a general surgeon to have the mass removed
E. Order ultrasonography or MRI

The correct answer is C
Educational Objectives
Evaluate a patient with an adrenal incidentaloma.
This patient presents with an adrenal incidentaloma. The first step in management is an evaluation of serum and urine hormone levels to determine whether the mass is functional or nonfunctional. If it is nonfunctional, follow-up CT and repeat hormone testing at 6 to 12 months are indicated to ensure the mass is not enlarging or beginning to produce hormones. At 2.8 cm, the mass has a low malignant or functional potential, and therefore there is no immediate indication for removal of the mass, biopsy, or further imaging.