A multidisciplinary approach to the management of adrenal incidentaloma

Introduction: An adrenal incidentaloma (AI) is an adrenal neoplasm incidentally-discovered during an imaging unrelated to suspected adrenal disease. The aim of the present review is to offer practical guidance on the multidisciplinary approach of AIs. Areas covered: The prevalence of AI is high in the aging population (up to 5-8%); however, hormonally-active or malignant conditions are rare. After the discovery of an AI, it is suggested to assess in parallel if the mass is potentially malignant and functionally active. The answer for the former question is mainly based on medical history (extra-adrenal malignancies, new-onset of signs or symptoms) and imaging (conventional radiology and/or nuclear medicine). The answer for the latter question is a complete endocrine evaluation for both cortical (glucocorticoids, mineralocorticoids) and medullary (catecholamines) secretion. Expert opinion: A multidisciplinary discussion is suggested for patients with adrenal disease, after the exclusion of non-functioning benign cortical adenoma, in order to plan a close and tailored follow-up for the suspected malignant or functioning forms. Surgery is advised for patients with malignant disease (adrenocortical cancer) or with clinically relevant secreting neoplasm (primary aldosteronism, Cushing’s Syndrome and pheochromocytoma).