Adrenal incidentaloma and adrenal carcinoma
Working up an adrenal mass found on imaging under the 2023 ESE/ENSAT guideline (unenhanced CT density, 1 mg dexamethasone test, who needs metanephrines and aldosterone-renin ratio), mild autonomous cortisol secretion, and recognising and treating adrenocortical carcinoma.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- An adrenal incidentaloma is a mass of 1 cm or more found on imaging done for another reason. They turn up in about 4% of abdominal CT scans and in up to 10% of older people.
- Most are benign non-functioning cortical adenomas. Adrenocortical carcinoma (ACC) is under 2% of incidentalomas; metastases matter mainly in people with known cancer.
- Two questions: is it malignant (unenhanced CT density, size, appearance) and is it functioning (1 mg dexamethasone suppression test for everyone; metanephrines and aldosterone-renin ratio for selected patients)?
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Sources
- Management of adrenal incidentalomas: European Society of Endocrinology clinical practice guideline in collaboration with the European Network for the Study of Adrenal TumorsESE and ENSAT (Fassnacht et al., Eur J Endocrinol 2023;189:G1-G42), 2023
- European Society of Endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal TumorsESE and ENSAT (Fassnacht et al., Eur J Endocrinol 2018;179:G1-G46), 2018
- Combination chemotherapy in advanced adrenocortical carcinoma (FIRM-ACT)Fassnacht et al., N Engl J Med 2012;366:2189-97, 2012
- Adjuvant mitotane versus surveillance in low-grade, localised adrenocortical carcinoma (ADIUVO): an international, multicentre, open-label, randomised, phase 3 trial and observational studyTerzolo et al., Lancet Diabetes Endocrinol 2023;11:720-30, 2023
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback