American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas © 2009

The incidence of adrenal incidentaloma, a term coined in reference to the phenomenon of detecting an otherwise unsuspected adrenal mass on radiologic imaging, has been increasing and now approaches the 8.7% incidence reported in autopsy series (1 [evidence level or EL 3], 2 [EL 3]). The definition of incidentaloma excludes patients undergoing imaging procedures as part of staging and work-up for cancer. Not only are more incidentalomas being detected by imaging but they are increasingly more likely to be functional because of the more common evaluations for subclinical syndromes (3 [EL 2]). During the evaluation of an adrenal mass, three questions need to be addressed: (1) Is the tumor hormonally active? (2) Does it have radiologic characteristics suggestive of a malignant lesion? and (3) Does the patient have a history of a previous malignant lesion?