All adrenal incidentalomas should be assessed for their functional status and risk of malignancy. Newly diagnosed patients should undergo screening with a focused history, examination and biochemical tests looking for signs of excess hormone secretion. Treatment of functional adrenal incidentalomas usually involves adrenalectomy, which may improve morbidity and mortality.
- All adrenal incidentalomas should be screened clinically (history and examination) and biochemically for evidence of autonomous hormone secretion, regardless of symptoms and/or signs.
- The risk of malignancy (primary or metastatic) should be determined at diagnosis, as adrenocortical cancer is an aggressive disease. Early identification and prompt complete surgical resection offer the greatest chance of cure.
- Co-secretion of adrenal androgens and glucocorticoids is due to a primary adrenocortical cancer until proven otherwise.
- For nonfunctional, benign adenomas routine surveillance imaging and biochemistry is not needed unless new symptoms and/or signs develop concerning for hormone hypersecretion and/or malignancy.
- Patients with subclinical Cushing’s syndrome from an adrenal adenoma should be assessed individually to determine benefits of operative intervention.