Unilateral or bilateral adrenalectomy is performed for a variety of indications, including hormonal excess or suspected malignancy. Preoperatively, it is important to determine whether there is an indication for surgery and whether a fine needle aspiration biopsy is indicated. In addition, all patients with adrenal masses should undergo a clinical and biochemical evaluation for hormonal excess (excess cortisol, aldosterone, catecholamines, sometimes androgens). Postoperatively, patients should be assessed for hormonal deficiencies and hormone replacement therapy initiated if indicated with appropriate patient education. Patients need follow-up after surgery to manage their endocrine status and follow up the histopathologic diagnosis.