A 46-year-old man has mild renal failure and hypeension which is proving difficult to manage. CT scan shows both a small adrenal tumor and bilateral hyperplasia. Which of the following is the best test to make a definitive diagnosis?: (A) Dexamethasone suppression test, (B) NP-59 adrenal scintigraph, (C) Adrenal MRI, (D) Selective adrenal vein sampling
Answer is D. Option A- Useful for diagnosis of Cushing syndrome Option B- Used for the diagnosis of Pheochromocytoma (which doesn't have renal failure) C/P given as B/L hyperplasia + Small adrenal tumor = ADRENAL ADENOMA (cause of Conn's Syndrome) Option C- Since CT scan has already been done so MRI is not that useful. Option D- useful as it can enable us to see the hormones produced by the tumor.