Adrenal Incidentaloma: Differential Diagnosis and Workup

Adrenal incidentalomas (AIs) are adrenal masses greater than 1 cm found incidentally on abdominal imaging not related to adrenal disease and occur in approximately 2% of the population. Adrenocortical adenoma is the most common cause of AIs, and the majority are non-secreting. Patients with secretory adenomas may experience overproduction of various hormones, such as glucocorticoids, mineralocorticoids, and in rare cases, estrogens, or androgens. Symptoms associated with this diagnosis are usually absent; however, evaluation for hormonally active tumors and signs of metastasis should be evaluated during the initial workup. Management of AIs involves a multidisciplinary team, consisting of an endocrinologist, surgeon with expertise in adrenal surgery, and radiologist, with consideration for genetic counseling. Diagnosis and treatment require a careful approach with a multidisciplinary team and individualized management based on the etiology. Minimally invasive adrenalectomy is the gold standard for most adrenal masses, but an open approach should be considered for adrenal cortical carcinomas. Small, benign non-functional masses do not require follow-up. Small nodules with indeterminate imaging characteristics should undergo imaging in 6–12 months to confirm stability.