Adrenal Incidentaloma

Adrenal incidentalomas, detected incidentally during imaging for unrelated conditions, are found in 1–6% of adults, with higher prevalence in older populations. Most are benign, nonfunctioning adenomas, but 14% secrete excess cortisol, aldosterone, or catecholamines, while 4% may be malignant. This review outlines a systematic approach to evaluation, emphasizing biochemical testing for hormonal excess (e.g., 1mg dexamethasone suppression test for cortisol, plasma metanephrines for pheochromocytoma) and imaging features (e.g., Hounsfield units on CT) to assess malignancy risk. Key recommendations include adrenalectomy for pheochromocytoma after alpha blockade and individualized management for mild autonomous cortisol excess or primary hyperaldosteronism. Nonfunctioning tumors <4 cm with ≤10 Hounsfield units typically require no follow-up. Multidisciplinary collaboration is advised for indeterminate or high-risk cases.

Adrenal incidentalomas, detected incidentally during imaging for unrelated conditions, are found in 1–6% of adults, with higher prevalence in older populations. Most are benign, nonfunctioning adenomas, but 14% secrete excess cortisol, aldosterone, or catecholamines, while 4% may be malignant. This review outlines a systematic approach to evaluation, emphasizing biochemical testing for hormonal excess (e.g., 1mg dexamethasone suppression test for cortisol, plasma metanephrines for pheochromocytoma) and imaging features (e.g., Hounsfield units on CT) to assess malignancy risk. Key recommendations include adrenalectomy for pheochromocytoma after alpha blockade and individualized management for mild autonomous cortisol excess or primary hyperaldosteronism. Nonfunctioning tumors <4 cm with ≤10 Hounsfield units typically require no follow-up. Multidisciplinary collaboration is advised for indeterminate or high-risk cases.