UNILATERAL ADRENAL INCIDENTALOMA AND TREATMENT DECISIONS

Abstract

Unilateral adrenal incidentaloma requires an evaluation that identifies hormonal hypersecretion and malignancy without exposing people with benign lesions to unnecessary interventions. This critical narrative review aims to integrate initial evaluation with decisions about surgery, follow-up, and discontinuation of lesion-specific surveillance in adults. The bibliographic approach combines PubMed searches, supplementary consultation of regional sources, and reading of guidelines and studies selected for clinical relevance, updated through October 2026. The synthesis distinguishes radiological characterization from functional diagnosis, discusses limitations of hormonal testing, and compares recommendations with recent trials of adrenalectomy for mild autonomous cortisol secretion. Homogeneity and low attenuation on unenhanced computed tomography help identify lesions with benign features, while endocrine evaluation detects conditions that may require treatment even in this group. Trials support a possible surgical benefit for blood pressure control in selected patients, but show less consistent results for other metabolic outcomes and do not establish a reduction in mortality. Three tables connect tests, findings, and clinical decisions. The review concludes that the quality of the initial evaluation, confirmation of hormonal abnormalities, comorbidity burden, and patient preferences should guide care proportional to risk, with follow-up directed at clinically relevant uncertainty.