Medical history A previously healthy 30-year-old female patient complained of dry cough and persistent dyspnea which had begun a month before and showed no response to antibiotics or corticoids. She also reported epigastric pain, vomiting and copious sweating. On examination, she was normotensive and tachycardic. Both computed tomography and 123-I-metaiodobenzylguanidine (MIBG) scintigraphy revealed an adrenal mass. Figure 1: Coronal reconstruction of abdominal computed tomography (CT)Figure 2: 123-I-metaiodobenzylguanidine (MIBG) scintigraphy Question:Taking the clinical data and imaging studies into consideration, it's reasonable to assert that: The imaging findings are compatible with an adrenal incidentaloma, which has primary adrenal carcinoma as its major cause. Adrenal metastases are the most likely diagnosis. A fine-needle aspiration (FNA) should be carried out to better evaluate the mass. Pheochromocytoma is a potential diagnosis. Therefore, products of catecholamine metabolism (metanephrine and normetanephrine) should be measured either in urine or plasma. Time is Up! Time's up
