Management of the incidentally discovered adrenal mass or "incidentaloma"

The prevalence of an incidentally discovered adrenal mass or "incidentaloma" by abdominal computerized tomography (CT) scan is 1% to 2%. The majority of patients with incidentalomas do not have clinical manifestations nor require further treatments of their incidentalomas. Thus the goal for their management is two-fold: 1) To identify and treat the hormonally hyperactive adrenal adenoma and the rare adrenal carcinoma, and 2) To avoid creating an iatrogenic disease of medical progress. An adrenal mass > or = 6 cm, excluding metastatic malignant disease, needs to be surgically resected due to the risk for carcinoma. The risk of primary adrenal cancer for a hormonally inactive lesion < or = 3 cm is extremely low and can be safely observed. Treatment for the hormonally inactive lesion between 3 and 6 cm must be individualized, based on age, specific scan characteristics (irregular border, local invasion, metastasis), and clinical status of the patient. All hormonally active adrenal adenomas should be surgically resected. In this article, we review the data to support the above recommendations.