Incidentally discovered adrenal tumors

The introduction of computed tomography has dramatically increased the detection and in turn the incidence of incidentally identified adrenal abnormalities; the current incidence rate is approximated at 2%. Improvements in technology can be expected to increase the reported incidence even further and magnify the clinical problem these abnormalities pose. Although most clinicians would agree that surgery is indicated in patients with primary adrenal malignancy and those with significant endocrine function, strategies for the management of patients with incidentally identified lesions remain controversial. One approach is to base the risk of primary adrenal malignancy on lesion size and undertake biochemical evaluation only for patients who, on clinical grounds, are likely to have endocrinopathy. Another approach is to assess endocrine function (biochemically and radiographically) in all patients and recommend surgery or additional evaluation (eg, needle biopsy) for those found to have abnormalities. Recent studies of patients with benign, incidentally discovered adrenal lesions suggest that these common lesions are almost all hormonally functional to some extent. The natural history of subclinical but functioning adrenal adenomas is not known.