Diagnostic Testing for Elevated Cortisol in the Setting of an Adrenal Mass

A 66-year-old man with history of type 2 diabetes, hypertension, and dyslipidemia presented with a 3.1-cm left adrenal mass, detected on a computed tomographic (CT) scan (performed to evaluate bilateral lung infiltrates identified on chest radiograph during evaluation of chronic cough). He had no headache, palpitations, fatigue, muscle weakness, or weight change. His medications were glipizide, metformin, metoprolol, and atorvastatin. He had no history of fractures or osteoporosis. His blood pressure was 139/88 mm Hg, heart rate 92 beats/min, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) 37.0. Purple striae, proximal muscle weakness or supraclavicular fat pads were not present. The mass was round and homogenous with a CT attenuation of 24 Hounsfield units (HU). Laboratory evaluation was performed (Table).