Kasperlik-Zaluska et al listed indications for surgical resection of an adrenal incidentaloma. The authors are from the Medical University of Warsaw and the Maria Sklodowska-Curie Memorial Cancer Center in Warsaw, Poland.


Indications for surgery related to high risk of malignancy:

(1) high unenhanced CT attenuation (> 20 HU)

(2) rapid growth

(3) diameter >= 5 cm (>= 4 cm may be used)

(4) delayed washout of contast medium

(5) other reasons to suspect a primary or metastatic carcinoma


Other reasons to consider adrenal surgery:

(1) pheochromocytoma (chromaffin tumor)

(2) endocrine hyperfunction

(3) acute retroperitoneal hemorrhage associated with the adrenal mass



• A benign adrenal tumor tends to have a CT density <= 10 HU.


If bilateral tumors are present in a patient with Cushing's syndrome and if one adrenal gland is to be removed, then the one to remove is selected based on one or more of the following:

(1) larger size

(2) more rapid growth

(3) higher density on CT images


To read more or access our algorithms and calculators, please log in or register.