[Adrenal incidentalomas]

Abstract

The adrenal incidentaloma is an adrenal mass, generally more than 1 cm in diameter, that is discovered serendipitously during a radiologic examination performed for indications other than an evaluation of adrenal disease. The prevalence of adrenal incidentalomas is at least 1% in patients who underwent abdominal CT examination. The main therapeutic issues are to select which patient should undergo surgical excision, and the optimal procedure and duration of follow-up for patients in whom surgery is not indicated. Surgery is mandatory in patients with secretory tumours (pheochromocytoma, secreting cortical adenomas) and with adrenal cancer. However, the vast majority of adrenal incidentalomas are benign cortical adenomas and surgery is mandatory only in a minority of patients. Systematic aetiological investigation of adrenal incidentalomas should therefore be performed in order to guide the decision on surgical or non surgical management. This investigation includes, at least, clinical assessment, biological endocrine evaluation and appropriate standardized CT scan examination of the mass. The optimal duration and modalities of follow-up for patients with adrenal incidentalomas are uncertain.