[Adrenal incidentalomas--is the present management rational?]

Adrenal incidentalomas, i.e. clinically inapparent adrenal mass, are considered to be one of the most frequent tumours in human pathology. They more frequently occur in women, older age, patients with metabolic syndrome and in patients with malignant diseases. The first step in the management is exclusion of hormonal activity and differentiation of malignant and benign lesions. At present, there is no consensus with respect to differential diagnosis and treatment of adrenal incidentalomas since the development of hormonal hyperfunction and a risk of malignancy are negligible. The most frequent cause ofhyperfunction is subclinical hypercortisolism, the clinical significance ofwhich is also questionable. Recently, it has been shown that the existing recommendations lack rationality and, in addition, increase risk of falsely positive hormonal investigations. Repeated CT scans subject the patients to ionising radiation and may carry the same or even higher risk ofcancer than the risk ofmalignant transformation of adrenal incidentaloma. This is why it is important to develop recommendations for screening and subsequent 'follow-up' that will be rational, safe for the patient and reliable.