Appropriate laboratory screening tests include the following: a 24-hour urinary free cortisol measurement for patients with evidence of Cushing's syndrome a 24-hour urinary metanephrine, vanillylmandelic acid or catecholamine measurement for patients with evidence of pheochromocytoma and a serum potassium level for patients with evidence of hyperaldosteronism. Referral is indicated for patients with incidental adrenal masses more than 6 cm in greatest diameter. The need for referral of patients with adrenal masses is determined by careful assessment of clinical signs and symptoms, as well as the results of screening laboratory studies and appropriate radiologic studies.

Magnetic resonance imaging is indicated in patients with indeterminate renal masses, and referral is required in patients with symptoms or solid masses. Patients with minimally complicated renal cysts can be followed radiographically. Asymptomatic patients with simple renal cysts require no further evaluation. A practical and cost-efficient means of evaluating renal lesions combines ultrasonography and computed tomographic scanning, with close communication between the family physician and the radiologist. The only time to consider a biopsy of an adrenal tumor is if the patient has another cancer, typically of the lung, kidney, breast, colorectal or melanoma and one is suspecting an adrenal metastasis. Knowledgeable family physicians can reliably diagnose these masses, thereby avoiding unnecessary worry and procedures for their patients. Incidental renal or adrenal masses are sometimes found during imaging for problems unrelated to the kidneys and adrenal glands.

Adrenal nodule on kidney