Morning aldosterone > 15 ng/mL with an aldosterone-to-renin ratio of >30 is indicative of Conn syndrome (hyperaldosteronemia).Ĭonfirmatory testing with sodium loading is indicated. Patients should be off potassium sparing diuretics and mineralocorticoid receptor blockers for six weeks before testing. If aldosterone testing is normal and there is a strong suspicion for hyperaldosteronism (Conn syndrome), stop angiotensin converting enzyme inhibitor and repeat aldosterone testing. Replace potassium if low potassium as hypokalemia can cause false positive results.Īngiotensin converting enzyme inhibitors can cause false negative aldosterone testing. Metanephrine values four times normal are diagnostic of pheochromocytoma, lower values are equivocal results. If metanephrines are positive, stop beta blocker and repeat metanephrine testing. Must have normal kidney function.Ī morning serum cortisol greater than 5 g/dl is diagnostic of Cushing syndrome.īeta blockers can cause false positive metanephrine results. 24 hour urine collection for metanephrine level, creatinine level.Alternative to above plasma free metanephrines:.24 hour urine collection for cortisol level, creatinine level.Removal is recommended for nodules over 6 cm, or over 4 cm in young, healthy patients.Īlternative to above low dose dexamethasone test: Very rarely, the nodule can be cancerous. Therefore, some experts recommend blood work every year for three to four years for nodules larger than 3 cm. However, 20% of nodules larger than 3 cm can show excess hormone production on repeat testing. Nodules less than 3 cm that do not make extra hormones are not likely to make extra hormones on repeat testing. Imaging studies such as CT or MRI are recommended at 6, 12 and 24 months after the nodule is first seen. If the nodule is over 1 cm, blood work is recommended to see if the nodule is making excess hormones. However, about 10% of the time, the nodule can make too much hormone and cause problems in the body.

Most of these nodules do not cause any harm and can be left alone. By 70 years of age, up to 7% of people have a nodule in the adrenal gland. An adrenal nodule is a growth in the adrenal gland. They make several hormones important for normal body function. The adrenal glands sit above the kidneys, one on each side of the body.

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Nodular adrenal gland