Adrenal incidentalomas -- a continuing management dilemma

Adrenal incidentalomas (AI), adrenal tumors detected through an imaging procedure done for reasons unrelated to adrenal dysfunction, is becoming a common clinical problem with the more frequent utilization of different imaging techniques. Most such tumors are benign and hormonally inactive. A variety of diagnostic strategies have been developed to distinguish the latter; however, they are still controversial. Even after a commissioned systematic review of the literature and a state of the science conference sponsored by the National Institutes of Health, the optimal strategy for hormonal screening of a patient with AI is unknown, but we anticipate further refinements and major advances in the field. Surgery is the ultimate solution for the diagnostic-therapeutic dilemma of AI. Careful planning is required, and the learning curve which influences clinical decision making is especially relevant to immediate outcomes. The benefit of making a diagnosis of a clinically significant AI must be considered in the context of the patient's overall condition and preferences.