Health condition
Adrenal incidentaloma workup
An adrenal incidentaloma is a nodule found by chance on a scan done for something else; most are harmless, but every one needs two questions answered - is it secreting hormones, and could it be malignant?
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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Found on around 1 in 20 abdominal CT scans, mostly benign non-functioning adenomas
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Hormone workup for all: overnight 1 mg dexamethasone suppression test (cortisol), plasma or urinary metanephrines (phaeochromocytoma), and aldosterone-renin ratio if there is hypertension or low potassium
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Imaging features - size, density (Hounsfield units) and growth - assess cancer risk
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Mild autonomous cortisol secretion is the commonest abnormality and affects bone, weight and blood pressure
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Specialist: a consultant endocrinologist; surgery is reserved for functioning or suspicious nodules
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
As scanning has multiplied, so have chance adrenal findings. The overwhelming majority are benign adenomas doing nothing, but a minority secrete cortisol (often subtly), adrenaline-type hormones or aldosterone, and a small number are cancers. Size above 4 cm, high density on unenhanced CT, irregular borders or growth over time raise concern; a small, lipid-rich, stable nodule is reassuring.
Diagnosis and treatment routes
Guideline workup is standard and worth insisting on: an overnight dexamethasone suppression test, plasma or urine metanephrines for every nodule, and an aldosterone-renin ratio when blood pressure or potassium suggests it, alongside review of the imaging characteristics. Clearly benign, non-functioning nodules under 4 cm generally need no long-term follow-up. If you have been told of an adrenal nodule and no hormone tests have followed, see an endocrinologist; private appointments are typically available within about two weeks, against NHS waits often of 20-45+ weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant endocrinologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Adrenal incidentaloma workup.
Quick, plain-English answers to what people ask us most.
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What is an adrenal incidentaloma?
An adrenal incidentaloma is a growth found on the adrenal gland by chance during imaging performed for an unrelated reason, most of which turn out to be harmless, non-functioning benign tumours.
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What does the workup for an adrenal incidentaloma involve?
Workup typically includes blood and urine hormone tests to check whether the growth is producing excess hormones, and further imaging to assess its size, appearance, and growth over time.
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Why is hormone testing important for an adrenal incidentaloma?
Even small adrenal growths can sometimes secrete excess hormones such as cortisol or adrenaline without obvious symptoms, so testing helps identify hormonally active tumours that need specific treatment.
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Is an adrenal incidentaloma dangerous?
Most are benign and harmless, but a small proportion are hormonally active or, rarely, cancerous, which is why appropriate workup is recommended even for growths found incidentally.
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How is an adrenal incidentaloma monitored?
If initial workup is reassuring, monitoring may include a repeat scan after six to twelve months to check for growth, along with periodic hormone testing depending on initial results and imaging features.
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When is surgery needed for an adrenal incidentaloma?
Surgery is generally recommended if the growth is hormonally active, has imaging features suggestive of malignancy, or is growing significantly over time on follow-up imaging.
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How long does the workup process take?
Initial hormone testing and imaging review typically takes a few weeks, with a decision on further monitoring or specialist referral made once results are available.
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Adrenal incidentaloma workup vs routine adrenal disease investigation — what's the difference?
Routine investigation is prompted by symptoms suggesting a hormone problem, while incidentaloma workup is prompted by an unexpected imaging finding in someone without obvious symptoms, requiring a systematic approach to rule out hidden hormone excess or malignancy.
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What imaging features suggest an adrenal incidentaloma might need closer attention?
Larger size, irregular borders, high density on CT scan, or significant growth on follow-up imaging are features that increase suspicion and typically prompt specialist referral or biopsy consideration.
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When should I see a specialist about an adrenal incidentaloma, and how quickly can I be seen privately?
See an endocrinologist for any adrenal incidentaloma finding. NHS referral can take many weeks, while private specialist assessment is often available within about two weeks.