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An adrenal incidentaloma is an adrenal mass detected incidentally during imaging (CT, MRI, or ultrasound) performed for a reason unrelated to adrenal disease, such as abdominal pain, trauma, or cancer staging. By definition, it excludes adrenal lesions found during a dedicated adrenal workup or as part of workup for known extra?adrenal cancers.

Most adrenal incidentalomas are non?functioning benign adrenocortical adenomas, causing no symptoms yet accounting for a rising proportion of adrenal lesions in adults, especially over 50 years. A smaller subset shows hormone excess—subclinical or overt Cushing’s syndrome, primary aldosteronism, pheochromocytoma, or adrenal?androgen overproduction—warranting further endocrine testing. Imaging features such as size, density, wash?out characteristics, and growth on follow?up help stratify risk of malignancy, including adrenocortical carcinoma.

Expert guidelines recommend clinical assessment for hormone?excess signs, a 1?mg overnight dexamethasone suppression test, and targeted biochemical panels depending on suspicion, followed by tailored imaging review. Lesions larger than about 4?cm, those with suspicious imaging features, or confirmed hormone?secreting tumors are usually referred for surgical removal, whereas smaller, apparently benign incidentalomas are monitored with periodic imaging and hormone re?evaluation. This approach balances oncologic risk against the morbidity of unnecessary surgery.