What is an Incidentaloma?

It is a mass (lump) found accidentally in the adrenal gland on a CT scan or MRI done for an unrelated reason (like checking for kidney stones or abdominal pain). They are surprisingly common (found in about 4-7% of scans).

Main Questions to Answer:

1. Is it making hormones? (Functional vs. Non-Functional)
2. Is it cancer? (Benign vs. Malignant)

Hormonal Workup:

All incidentalomas need blood/urine tests to rule out:

• Pheochromocytoma: Plasma metanephrines.
• Primary Hyperaldosteronism: Aldosterone-to-renin ratio (if blood pressure is high).
• Cushing's Syndrome: 1mg Dexamethasone Suppression Test (even if you have no symptoms).

Cancer Risk:

Features suggesting cancer:

• Size: >4 cm.
• Appearance on CT: Irregular borders, high density (>10 Hounsfield Units).
• Growth: Growing over time.

Management:

• Small (<4 cm) & Non-Functional: Repeat CT in 6-12 months to ensure it's not growing.
• Large (>4 cm) or Suspicious: Surgery to remove it.
• Functional (Making Hormones): Surgery, regardless of size.