[Adrenal disease diagnosis: management of adrenal incidentaloma]

Adrenal glands are specialized in biosynthesis of several hormones correlated to different clinical phenotypes in case of excess or lack of production. In addition to secretion disorders, tumors, secreting or not, can take place in adrenal glands. Incidentalomas are the most common adrenal diseases in clinical practice. The challenge of the management is to determine whether the lesion is benign or malignant and secreting or not in order to direct therapeutic management towards surgical option, pharmacotherapy or clinical follow-up. Several radiographic characteristics allow to predict the benign or malignant nature of a lesion (size and density of the tumor, fat content,...). Adrenal carcinoma is a very rare cancer but should be excluded because its extremely poor prognosis. If most incidentalomas are non-secreting, it is important to ensure that there is no Cushing syndrome, even subclinical (± 10 % of incidentalomas) or pheochromocytoma (± 10 % of incidentalomas), pathologies associated with a higher incidence of cardiovascular complications. Careful clinical evaluation for symptoms and signs related to excessive adrenal hormones production is recommended to prescribe appropriate hormone assays. Finally, the surgical indication will be guided by the probability of malignancy, the presence and the degree of hypersecretion but also the age, the general health and the choice of the patient.