ABSTRACT
The discovery of an adrenal mass in the course of abdominal imaging performed for other reasons, ‘‘adrenal incidentaloma,’’ is a common clinical problem that poses a challenging management dilemma (1). This dilemma arises because while most incidentalomas will be clinically insignificant benign and hormonally inactive adenomas that neither pose a risk to a patient’s health nor warrant the risks of further diagnosis and treatment, there may be some lesions that do pose a significant risk, either because of their hormonal activity or because of their malignant histology. The challenge is to recognize and treat these few, while leaving the others alone. As imaging techniques improve and their use becomesmore widespread, we can expect to encounter this challenge more frequently. Over the years a myriad of approaches has been recommended: strategies for hormonal screening, radiological testing, and histopathological examination. However, even after a commissioned systematic review of the literature and a consensus conference sponsored by the National Institutes of Health, controversies remain and the medical decisions are laced with uncertainty (2,3).
