How to manage adrenal incidentaloma in a hypertensive patient?

Adrenal incidentaloma (AI) is a mass discovered on imaging not performed for suspected adrenal diseases. Technological advancements and increasing availability of imaging modalities, along with a growing awareness of preventive care and an aging population, have led to an increase in AI detection, generating diagnostic and therapeutic dilemmas for clinicians. Every patient with AI should undergo a careful evaluation to establish the etiology of the tumor and detect all hormonally active lesions, including those that cause secondary hypertension. Hormonal hypertension carries a higher risk of cardiovascular complications and target organ damage than essential hypertension, independently of blood pressure control. In this review, we discuss the current 2023 European Society of Endocrinology guidelines on the management of AIs in the context of other expert documents (including recommendations of the Polish Society of Endocrinology), with the main focus on 2 secondary forms of hypertension-primary aldosteronism and pheochromocytoma-that should not be missed in clinical practice.