Adrenal Incidentaloma

What is an adrenal incidentaloma?

An adrenal incidentaloma is a growth of the adrenal gland, detected on imaging done for other reasons. They become more common as we age, found in 7% of people over 70 years of age. They are usually benign and non-functioning (not producing hormones).

What are the symptoms and signs?

Most patients have no symptoms. Rarely, if the tumor is making hormones, patients may experience symptoms related to the hormones being produced (see the other adrenal disorders in this section to read more).

How is an adrenal incidentaloma diagnosed?

Most often, adrenal incidentalomas are picked up on abdominal ultrasound, CT, or MRI, that was performed for other reasons. Once identified, blood testing will be performed to check the growth is not making too much of a hormone (adrenaline, cortisol, or aldosterone). The appearance of the mass and its size on imaging will be assessed to look at the likelihood of cancer, which fortunately is quite rare.

How is an adrenal incidentaloma treated?

Two features of adrenal nodules greatly influence management decision-making: the size and the functionality.  For nodules greater than 6cm in size, surgery is typically recommended due to the increase chance of cancer.  Also, nodules that make an excess of adrenal hormones often (but not always) require surgery.  If surveillance is recommended, the nodule is closely followed on imaging (MRI or CT) every 6 months for one year to assess stability (no growth). If the blood work is abnormal and reveals significant overproduction of hormones, or the appearance or size of the growth on CR or MRI is concerning for cancer, surgery (adrenalectomy) may be recommended.  If the growth appears benign and there is a mild overproduction of some hormones, sometimes the condition can be treated medically with pills.

What can I expect after surgery?

If surgery is recommended, > 90% of patients are candidates for minimally invasive surgery—surgery is done with small incisions, and most patients can expect a quick recovery in most cases, with a 1-2 night hospital stay.