Approach to the patient with an adrenal incidentaloma

This algorithm must be used in conjunction with the UpToDate topic on the evaluation and management of the adrenal incidentaloma that describes biochemical evaluation followed by confirmatory testing if needed, as well as imaging features.

CT: computed tomography; DHEAS: dehydroepiandrosterone sulfate; DST: dexamethasone suppression test; FNA: fine-needle aspiration; HU: Houndsfield units; PAC: plasma aldosterone concentration; PRA: plasma renin activity.

* The initial biochemical testing is to determine if the incidentaloma is hormonally active. Testing is performed for subclinical hypercortisolism, pheochromocytoma, and primary aldosteronism.

¶ If there is evidence of hormonal hypersecretion, additional confirmatory testing is performed (refer to related UpToDate content on the evaluation and management of the adrenal incidentaloma).

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Approach to the patient with an adrenal incidentaloma