Management of adrenal incidentalomas: Working through uncertainty

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• The 2016 European Society of Endocrinology guidelines addressed adrenal incidentalomas to prevent over-diagnosis and over-treatment.
• These guidelines aimed to reduce unnecessary investigations, surgery, and follow-up for adrenal incidentalomas.

Purpose of the Study:

• To critically re-evaluate specific recommendations from the 2016 guidelines.
• To incorporate recent literature published after 2016 into the assessment of adrenal incidentaloma management.
• To address debated aspects including imaging, pheochromocytoma diagnosis, autonomous cortisol secretion, and follow-up strategies.

Main Methods:

• Comprehensive literature review of studies published after the 2016 recommendations.
• Critical analysis of evidence regarding imaging, biochemical testing, and surgical indications for adrenal incidentalomas.
• Evaluation of diagnostic criteria and management protocols for specific adrenal tumor types.

Main Results:

• Identified areas of debate in the 2016 guidelines requiring updated recommendations.
• Highlighted recent studies that challenge or support existing diagnostic and treatment algorithms.
• Provided an updated perspective on the management of adrenal incidentalomas, particularly concerning autonomous cortisol secretion and pheochromocytoma.

Conclusions:

• The 2016 guidelines require reconsideration in several areas based on evolving research.
• Updated evidence supports refining diagnostic and treatment strategies for adrenal incidentalomas.
• A balanced approach is needed to avoid both under- and over-management of these tumors.