American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the size cutoff for an immediate adrenalectomy?

3 cm
4 cm
5 cm
6 cm

The correct answer is: 4 cm

The size cutoff for an immediate adrenalectomy is commonly recognized as being 4 cm. This benchmark is significant due to the increased risk of malignancy associated with adrenal masses larger than this size. Adrenal tumors equal to or exceeding 4 cm raise concerns for adrenocortical carcinoma, particularly if there are associated features suggesting malignancy, such as irregular borders or heterogeneous imaging characteristics. In clinical practice, imaging studies, such as CT scans, are used to assess adrenal masses and determine the most appropriate management strategy. If a mass is found to be 4 cm or larger, it is typically indicated for surgical evaluation. This threshold assists clinicians in making timely decisions to prevent potential complications or metastases resulting from undiagnosed malignant adrenal tumors. Tumors smaller than this size often can be observed or monitored, particularly if they appear benign based on imaging characteristics.