ABSTRACT
An adrenal incidentaloma is an adrenal mass found on imaging during an evaluation for an unrelated issue. Adrenal incidentalomas should prompt hormone evaluation to rule out Cushing’s syndrome, pheochromocytoma, and, if the patient has hypertension, primary hyperaldosteronism. If the mass is hyperfunctioning, the patient should undergo surgery ideally during the second trimester. If the mass is non-functioning and smaller than 4 cm, then the patient should have hormonal evaluation periodically to ensure that the incidentaloma remains non-functional. If the mass is non-functioning but is ≥4 cm, the patient should have surgery due to an increased risk of malignancy in adrenal lesions ≥4 cm. Biopsy of any adrenal lesion is contraindicated until a pheochromocytoma has been ruled out. Biopsy of an adrenal lesion cannot differentiate between an adrenal adenoma and an adrenocortical carcinoma.
