Adrenal "incidentalomas". Need for surgery

A series of eleven adrenal tumors is presented. Only one of the adrenal tumors showed evidence of endocrine function while eight tumors were incidentally discovered during radiologic evaluations. Surgical exploration was performed in all cases as the final diagnostic measure. There were four malignancies, three nonfunctioning carcinomas, and one neuroblastoma. Two of the four malignancies were discovered incidentally on radiologic evaluation and were considered preoperatively to be benign cystic lesions by radiographic criteria. One benign adrenal hamartoma was diagnosed preoperatively as an adrenal carcinoma. In view of the questionable accuracy of radiologic diagnosis of adrenal masses and the well-documented difficulty in differentiating adrenal adenomas from carcinomas on histologic grounds, consideration should be given to the surgical exploration and excision of all adrenal masses discovered incidentally.