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Adrenal Incidentaloma — Evaluation Algorithm

Functional and radiological evaluation of incidentally detected adrenal masses.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Adrenal Incidentaloma — Evaluation Algorithm?

Adrenal incidentaloma is an adrenal mass incidentally detected on imaging examinations performed without suspicion of adrenal pathology. Its prevalence is 4-5% in CT series and increases with age.

Evaluation should answer two main questions: (1) Is the mass hormonally active? (screening for subclinical Cushing, pheochromocytoma, primary aldosteronism) and (2) Could the mass be malignant? (size, CT density, contrast enhancement pattern).

Size ≥4 cm, CT density ≥10 HU (unenhanced), irregular contour, heterogeneous structure, and rapid growth are features raising suspicion of malignancy. Non-functional <4 cm homogeneous low-density masses are usually benign adenomas.

Symptoms

Usually asymptomatic (incidentally detected)
Hypertension (pheochromocytoma or aldosteronoma)
Weight gain and cushingoid appearance (subclinical Cushing)
Hypokalemia (in aldosterone-secreting adenoma)
Virilization findings (in adrenocortical carcinoma — rarely)

Risk Factors

Advanced age (prevalence increases)
Obesity and metabolic syndrome
Hypertension (suggests hormonally active mass)
Known cancer history (possibility of adrenal metastasis)
Mass size >4 cm

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Endocrinology evaluation is recommended when an adrenal mass is detected on any imaging
  • If paroxysmal hypertension or palpitation attacks are present (suspicion of pheochromocytoma) → URGENT biochemical screening
  • If a rapidly growing adrenal mass is detected
  • If an adrenal mass is seen in a known cancer patient

Treatment Methods

01
Biochemical screening: 1 mg dexamethasone suppression test, plasma metanephrines, aldosterone/renin ratio (if hypertensive)
02
Radiological evaluation: CT density <10 HU supports benign adenoma
03
Surgery: For functional masses, ≥4 cm masses, or with malignancy suspicion
04
Surveillance: In non-functional <4 cm adenoma, hormonal and radiological follow-up at 6-12 month intervals
05
Glucocorticoid replacement after adrenalectomy (in subclinical Cushing)

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.