[Adrenal incidentaloma--a common dilemma]

Abstract

An adrenal incidentaloma is an adrenal tumor larger than 1 cm, incidentally detected in imaging studies carried out for other reasons than adrenal disease. The most frequent explanation is a benign, non-functional adenoma, other frequent diagnoses include cortisol- or aldosterone-secreting adenomas, pheochromocytoma, cortical carcinoma and metastatic lesions. The work-up includes hormonal screening tests to confirm or exclude excess hormonal secretion and unenhanced computed tomography (CT) to define the imaging phenotype (size, density, other characteristics). Hormonally active and potentially malignant incidentalomas should be surgically removed. It is recommended to operate nonfunctional incidentalomas greater than 4 cm and follow-up smaller nonfunctional adenomas with a repeat CT.