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Introduction

Adrenal incidentalomas are adrenal masses discovered inadvertently during imaging studies performed for reasons unrelated to suspected adrenal disease.  The widespread use of high-resolution imaging techniques has led to an increase in the incidental detection of these lesions.  Although most are benign and nonfunctioning, a significant minority (10%-15%) can be malignant or hormone-producing, necessitating careful evaluation and management.  The clinical significance of adrenal incidentalomas lies in distinguishing benign from malignant lesions and determining whether they are hormonally active because these factors influence the management approach.

Pathogenesis

The mechanisms that lead to the development of adrenal incidentalomas are not fully understood.  However, several factors may contribute to their formation:

  • Genetic alterations:  These changes may be sporadic mutations (eg, PRKACA, beta-catenin) or, less commonly, hereditary mutations (eg,

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