What is an adrenal incidentaloma and do I need surgery?

An adrenal incidentaloma is an adrenal gland mass found unexpectedly on imaging performed for an unrelated reason. They are found in approximately 4–7% of abdominal CT scans in adults and are the vast majority of the time benign and non-functioning. When an incidentaloma is found, we perform two key assessments: first, is it producing excess hormones (we screen for cortisol excess, phaeochromocytoma, and for excess aldosterone); and second, what are its imaging characteristics. Surgery is generally recommended if hormonal excess is confirmed, if there are imaging features suspicious for malignancy, or if the tumour is large (typically greater than 4 cm). The majority of incidentalomas are safely monitored with periodic imaging and hormone testing without requiring surgery.