| Course | PA 522 Comprehensive Clinical Module Endocrinology |
|---|---|
| Week | 7 |
| Paper type | Incidental nodule workup |
| Length | About 780 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 522 Week 7
Incidental Nodule Workup: A 26 mm Left Adrenal Nodule Found on a Stone CT, Read at 6 Hounsfield Units, Screened for Three Kinds of Hormone Excess and Sent to Sampling Because Appearance Cannot Say Which Side Secretes
Student Name
Chamberlain University
PA 522: Comprehensive Clinical Module Endocrinology
Instructor Name
Month Day, Year
Incidental Nodule Workup: A 26 mm Left Adrenal Nodule Found on a Stone CT, Read at 6 Hounsfield Units, Screened for Three Kinds of Hormone Excess and Sent to Sampling Because Appearance Cannot Say Which Side Secretes
The Finding
A 26 by 22 mm left adrenal nodule, found on a noncontrast CT of the abdomen and pelvis ordered in March for right flank pain from a ureteral stone. It was not the reason for the scan, which makes it an adrenal incidentaloma by definition. The right adrenal gland appeared normal.
Function Before Appearance
The 2023 European adrenal incidentaloma guideline recommends that every patient with an incidentaloma be assessed for hormone excess, whatever the imaging shows, because a benign-looking nodule can still secrete (Fassnacht et al., 2023). Three screens were done.
A Screen With Reasons Attached
Cortisol excess: 1 mg dexamethasone at 11 p.m., cortisol at 8 a.m. Result 1.4 mcg/dL. The guideline uses 1.8 mcg/dL as the threshold below which autonomous cortisol secretion is excluded (Fassnacht et al., 2023). Excluded. This matters because mild cortisol excess raises cardiovascular risk and can cause adrenal insufficiency after surgery.
Aldosterone excess: screened because M.T. has hypertension and low potassium. The ratio of the two, about 53 on the April draw, was positive, and the May captopril challenge confirmed it, with aldosterone barely moving (Funder et al., 2016). Present.
Catecholamine excess: plasma free metanephrines measured because adrenal surgery was being considered and a pheochromocytoma must not be missed before any procedure. Result: metanephrine and normetanephrine both below the upper limit. Excluded.
Sex hormone excess: not screened, since M.T. has no clinical signs and the imaging is not suspicious.
Read the Imaging
Unenhanced attenuation: 6 Hounsfield units, measured over two thirds of the nodule, avoiding the edges.
Texture: homogeneous.
Margins: smooth and well defined.
Size: 26 mm, below the 4 cm size above which concern for malignancy rises.
Growth: no earlier imaging for comparison.
An attenuation of 10 units or lower on an unenhanced scan means the nodule is rich in fat, which is characteristic of a benign adrenocortical adenoma. The guideline advises that a homogeneous nodule under 4 cm with an attenuation of 10 units or lower needs no further imaging for malignancy (Fassnacht et al., 2023).
Non-Secreting Is Not Nothing
The aldosterone excess is real, but that does not mean this nodule makes it. Benign non-secreting adrenal nodules become more common with age, and in a person over 40 the nodule seen on CT may be a bystander while the excess aldosterone comes from the other gland or from both (Funder et al., 2016). Assuming the visible nodule is the source would risk removing the wrong gland. Equally, if sampling shows the nodule is not the source, it still deserves a line in the record as a known non-secreting adenoma, so that no future clinician repeats the entire workup.
The Disposition Block
Malignancy: very unlikely; no further imaging of the nodule is needed.
Cortisol: autonomous secretion excluded; no repeat screening needed unless new signs appear.
Catecholamines: excluded.
Aldosterone: confirmed primary aldosteronism; adrenal vein sampling at the regional center to decide whether one gland is responsible.
Thyroid: discordant results attributed to biotin, repeat pending before sampling.
Calcium: parathyroid hormone-dependent hypercalcemia under separate evaluation after the thiazide was stopped.
Communication
M.T. was told that the nodule looks benign, that it is not making excess cortisol or adrenaline, and that the aldosterone question is the one still being answered. M.T. was given a copy of the disposition block for the next specialist visit.
What Was Not Done, and Why
No contrast washout CT or MRI was ordered, because an unenhanced attenuation of 6 units already identifies a lipid-rich adenoma, and further imaging would add cost and contrast without changing the plan. No biopsy was considered: the guideline advises against adrenal biopsy except in narrow circumstances, such as a suspected metastasis from a known cancer, and only after a pheochromocytoma has been excluded (Fassnacht et al., 2023). No repeat imaging at six or twelve months was scheduled for the nodule itself.
The Workup in Order
March: stone CT shows the nodule. April: screening pair and dexamethasone test. May: medicines switched, potassium corrected, captopril challenge and metanephrines. June: thyroid discordance found and biotin stopped. July: adrenal vein sampling scheduled once the repeat thyroid tests return.
References
Fassnacht, M., Tsagarakis, S., Terzolo, M., Tabarin, A., Sahdev, A., Newell-Price, J., Pelsma, I., Marina, L., Lorenz, K., Bancos, I., Arlt, W., & Dekkers, O. M. (2023). European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology, 189(1), G1-G42. https://doi.org/10.1093/ejendo/lvad066
Funder, J. W., Carey, R. M., Mantero, F., Murad, M. H., Reincke, M., Shibata, H., Stowasser, M., & Young, W. F., Jr. (2016). The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 101(5), 1889-1916. https://doi.org/10.1210/jc.2015-4061
The Chamberlain PA 522 Week 7 instructions
The seventh week asks you to write the workup of an incidentally found endocrine nodule. Open by restating the finding in one line, including how it was discovered, since that affects how likely it is to be benign or functional. Put function before appearance: name the hormone screens appropriate to the gland and give the reason and threshold for each. Then read the imaging using the terms radiologists use, such as attenuation, texture, margins, size and growth, and say what each feature rules in or out. Explain why a nodule that does not secrete still matters. Close with a disposition block giving a status for every axis tested and every imaging question. Note any tests deliberately not ordered and why. Cite the current guideline for incidentaloma management.
How the PA 522 Week 7 example is put together
The workup begins with a 26 by 22 mm left adrenal nodule found on a noncontrast CT for a ureteral stone. A section cites the 2023 European guideline on testing every incidentaloma for hormone excess. Screens follow with reasons: a dexamethasone suppression result of 1.4 against the 1.8 threshold, an aldosterone excess confirmed earlier and plasma metanephrines below their limits; sex hormones are not screened. The imaging section reads 6 Hounsfield units, homogeneous texture, smooth margins and size under 4 cm as a lipid-rich adenoma needing no follow-up imaging. A section warns that the nodule may be a bystander to the aldosterone excess. The disposition block covers malignancy, cortisol, catecholamines, aldosterone, thyroid and calcium. Further sections list the imaging and biopsy not done and the workup timeline.
Where the points sit in the PA 522 Week 7 rubric
Grading here starts with order: a workup that describes the imaging before asking about hormone function loses the largest share, because function decides management. Faculty then check each screen for the right test, the right threshold and a stated reason; screens listed without reasons earn little. The imaging section is marked on using correct terms and tying each to what it excludes, rather than copying a radiology report. Credit goes to recognizing that a benign-looking nodule may be a bystander, which shows judgment about the limits of imaging. The disposition block is graded for completeness across every axis. Deductions apply for unnecessary tests, such as repeat imaging of a clearly benign nodule. The current guideline should be cited correctly.
PA 522 Week 7 help from the desk
Workups often go wrong when students start with the scan and add hormone tests as an afterthought. Give us the finding, how it was found and the results you have, and the workup written for you would restate the finding, put function first with a reason and threshold for each screen, and then read the imaging feature by feature. A section explains whether the nodule could be a bystander to any hormone excess in your case. The disposition block assigns a status to every axis tested. Tests deliberately not ordered are listed with reasons. If your nodule is thyroid or pituitary rather than adrenal, the same structure is used with that gland's screens. Check every threshold against the guideline your course assigns before you use the model.
Get a PA-522 Week 7 example written to your instructions
Send the case as your classroom states it, along with the instructions and any imaging report supplied, and a custom PA-522 Week 7 workup is written to it and returned inside 24 to 48 hours, the first one free. Anything from a patient you actually saw stays with you and never reaches the desk; the sample is built on constructed figures instead.
More PA 522 papers and MPAS samples
- PA 522 Week 1: Hormone Pair Discussion Post
- PA 522 Week 2: Feedback Axis Explainer
- PA 522 Week 3: Paired Hormone Interpretation
- PA 522 Week 4: Captopril Challenge Set
- PA 522 Week 5: Axis Level Write-Up
- PA 522 Week 6: Assay Interference Brief
- PA 522 Week 8: Monitoring Interval Rationale
- PA 520 Week 7: 6-Minute Walk Test Report
- PA 518 Week 7: Stroke Risk Scoring Memo
- PA 516 Week 7: Sinus Imaging Rationale
- PA 514 Week 7: Stop Date Justification
PA 522 Week 7 questions, answered
The assignment does not say which gland the mass is in. Is that an error?
Occasionally it is deliberate, to see whether a writer notices. A sample that meets this states the gland it has assumed and why the details given point there, then builds the functional block for that gland. If the case is genuinely ambiguous, the sample says which of two the reasoning would fork on. Send the exact wording and the assumption is made explicit either way.
Does a workup need a management plan at the end?
In this module, rarely. The disposition block says what the results imply for further testing and follow-up imaging, which is the assignment side of the line. Anything about treating the person is left to your clinical instruction. If your instructions explicitly ask for management, send them and the desk will tell you plainly what it can and cannot write into the sample.
Can I reuse the imaging report my section supplied?
Yes, and you should, since the sample is stronger when it reads the actual features your assignment provides rather than substituting generic ones. Attach the report with your request. Where the report uses measurements or descriptors your course has not covered, the sample explains them in the text so the reasoning stays legible to a marker.
Where can I find a free PA 522 Week 7 sample paper?
This page holds the full PA 522 Week 7 incidentaloma workup, a 26 mm adrenal nodule at 6 Hounsfield units screened for three kinds of hormone excess.
Why is no follow-up scan ordered in the PA 522 Week 7 sample?
A homogeneous nodule under 4 cm with an unenhanced attenuation of 10 units or lower is a benign adenoma under the 2023 guideline, so further imaging adds nothing.