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Health condition · Clinically reviewed

Benign adrenal tumours, from incidentaloma to a clear plan.

Most are silent adenomas found by chance. A short, structured workup separates the ones that need watching from the ones that need surgery.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against ESE, NICE and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice on adrenal incidentalomas, hormonal workup and laparoscopic adrenalectomy.

Key facts

Benign adrenal tumours at a glance.

The essentials, in plain English - what they are, how they behave, and how they are worked up in the UK today.

  • What it is

    A benign growth arising in one of the adrenal glands - most are non-functioning adenomas that make no extra hormone.

  • How common

    Adrenal incidentalomas are found on around 4 per cent of adult CT scans - the vast majority are benign adenomas.

  • Non-functioning

    Roughly 80 per cent make no excess hormone and are picked up by chance during imaging for another reason.

  • Functioning tumours

    A minority secrete cortisol (Cushing), aldosterone (Conn), catecholamines (phaeochromocytoma) or, rarely, sex steroids.

  • Cornerstone workup

    Every adrenal incidentaloma needs hormonal screening plus dedicated CT or MRI to define its behaviour.

  • Definitive treatment

    Laparoscopic adrenalectomy for functioning tumours, growing lesions or those over 4 cm with suspicious features.

Why this guide matters

A structured workup beats a worried wait.

Finding an adrenal lesion on a scan is alarming. Three principles shape everything else on this page and settle most of the anxiety.

  • Screen every incidentaloma

    Hormonal tests plus dedicated imaging are the minimum standard - it is how functioning tumours are caught early.

  • Size and imaging drive decisions

    Under 4 cm, benign imaging features and stable follow-up almost always mean surveillance rather than surgery.

  • Do not biopsy first

    Percutaneous biopsy risks seeding cancer and provoking a phaeochromocytoma crisis - it sits far down the pathway.

How the diagnosis is made

From incidental scan finding to a clear plan.

The steps a UK endocrinologist and adrenal MDT will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Incidental finding on imaging

    Most benign adrenal tumours are discovered on a CT or MRI ordered for unrelated abdominal, chest or renal symptoms.

  2. 02

    Assessing

    Focused history and examination

    A structured look for episodic hypertension, weight change, bruising, muscle weakness and virilising features.

  3. 03

    Assessing

    Hormonal workup - mandatory

    1 mg overnight dexamethasone suppression test, plasma or urinary metanephrines and aldosterone to renin ratio in every case.

  4. 04

    Confirming

    Androgen and oestrogen screen

    Testosterone, DHEAS and (rarely) oestradiol when there are virilising or feminising features on examination.

  5. 05

    Confirming

    Dedicated adrenal imaging

    Non-contrast CT with washout study or chemical-shift MRI - Hounsfield units under 10 and a 4 cm cutoff guide risk.

  6. 06

    Planning

    Selective functional imaging

    FDG-PET or MIBG scintigraphy in indeterminate lesions or suspected phaeochromocytoma - not routine for every adenoma.

  7. 07

    Planning

    Endocrine MDT and follow-up

    ESE guidance: repeat CT plus hormones at 6 to 12 months, then periodic review to 3 to 5 years for benign non-functioning lesions under 4 cm.

Typical timeline: a first scan to a settled plan in a few weeks.

Types

The main kinds of benign adrenal tumour.

The commonest is a silent non-functioning adenoma. A minority secrete hormones or arise from the medulla, and each has its own management path.

  • Non-functioning adenoma

    The commonest type - about 80 per cent. Silent, hormonally inactive and usually found on a scan done for something else.

  • Cortisol-secreting adenoma

    Overt Cushing syndrome or subclinical hypercortisolism - weight gain, easy bruising, glucose intolerance and hypertension.

  • Aldosterone-secreting (Conn)

    Resistant hypertension and low potassium - covered in depth in our primary aldosteronism guide.

  • Androgen or oestrogen secreting

    Rare - virilising features in women or feminising features in men warrant urgent endocrine review.

  • Phaeochromocytoma

    Catecholamine-secreting tumour of the adrenal medulla - episodic hypertension, palpitations and headaches. Around 10 per cent are malignant.

  • Myelolipoma

    A benign mix of mature fat and haematopoietic tissue - fat density on CT is diagnostic and treatment is usually observation.

  • Adrenal cyst or haemorrhage

    Simple cysts, pseudocysts and post-traumatic or anticoagulant-related haemorrhage. Rarely need surgery.

  • Red flag - suspicious features

    Size over 4 cm, growth on follow-up, high Hounsfield units or irregular margins push a lesion towards resection.

Treatment

How benign adrenal tumours are treated in the UK.

Surveillance for stable, small, non-functioning adenomas - and laparoscopic adrenalectomy after careful medical optimisation for the rest.

  • Active surveillance

    Non-functioning adenomas under 4 cm with benign features - repeat imaging and hormones per ESE, then discharge if stable.

  • Laparoscopic adrenalectomy

    The default for benign functioning tumours and lesions under 6 to 8 cm without invasion - short stay and excellent outcomes.

  • Open adrenalectomy

    Reserved for large tumours, suspected malignancy or lesions where laparoscopic access is unsafe.

  • Alpha-blockade for phaeo

    Phenoxybenzamine or doxazosin for 10 to 14 days before surgery to prevent an intraoperative catecholamine crisis.

  • Spironolactone or eplerenone

    Preoperative aldosterone antagonism in Conn syndrome to correct potassium and control blood pressure.

  • Metyrapone or ketoconazole

    Preoperative cortisol control for Cushing syndrome - mifepristone is used in selected cases.

  • Perioperative steroid cover

    After resection of a cortisol-secreting adenoma, glucocorticoid replacement is needed until the contralateral gland recovers.

  • Endocrine MDT and genetics

    Discussion at an adrenal MDT and referral for genetic testing where VHL, MEN2, neurofibromatosis type 1 or SDHx is suspected.

What this guide is based on

The sources behind every claim on this page.

UK and international specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your endocrinologist knows your history and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • European Society of Endocrinology and ENSAT. Clinical practice guideline on the management of adrenal incidentalomas.

  • NICE Clinical Knowledge Summaries. Adrenal disorders and hypertension referral criteria.

  • British Association of Endocrine and Thyroid Surgeons (BAETS). Standards for adrenal surgery.

  • Endocrine Society. Clinical practice guidelines on Cushing syndrome, primary aldosteronism and phaeochromocytoma.

Red flags

When an adrenal lesion needs urgent attention.

Most adrenal incidentalomas are truly benign. These are the situations that are not - and where a specialist opinion cannot wait.

  • Suspected phaeochromocytoma crisis

    Severe headache, sweating, palpitations and dangerously high blood pressure - a hypertensive emergency needing immediate hospital care.

  • Lesion over 4 cm

    Larger tumours carry a higher risk of adrenocortical carcinoma - surgical resection is generally recommended.

  • Growth on follow-up imaging

    An increase of 5 mm or more, or any change in imaging features, prompts earlier surgical discussion.

  • Rapid virilisation or feminisation

    Sudden onset of masculinising or feminising features can indicate a functioning cortical tumour - urgent endocrine review.

  • Bilateral adrenal masses

    Bilateral disease raises the possibility of congenital adrenal hyperplasia, metastases, lymphoma or a genetic syndrome.

  • New Cushingoid features

    Progressive central weight gain, thin skin, proximal muscle weakness and diabetes deserve prompt hormonal workup.

  • Resistant hypertension with hypokalaemia

    A classic pattern for primary aldosteronism - do not defer aldosterone to renin ratio testing.

  • Do not biopsy blindly

    Percutaneous biopsy risks seeding cancer and provoking a phaeochromocytoma crisis - it is not part of routine assessment.

  • Family or genetic history

    A personal or family history of VHL, MEN2, neurofibromatosis type 1 or SDHx mutations demands genetics referral.

Living with it

A manageable diagnosis, with a clear pathway.

Four things that make the biggest difference day to day - reassurance, steady follow-up, a good surgical plan and knowing your post-operative aftercare.

A quiet reminder

Structured follow-up beats endless scanning.

A short, planned surveillance course - then discharge when stable - is safer and less anxious than open-ended imaging.

  1. 01 Reassurance

    Most are truly benign

    Non-functioning adenomas under 4 cm with benign imaging features carry a very low risk and often need no more than a period of follow-up.

  2. 02 Follow-up

    Keep to the ESE schedule

    A single set of hormones plus one repeat scan at 6 to 12 months is usually enough to confirm stability.

  3. 03 Surgery

    Recovery is usually quick

    Laparoscopic adrenalectomy is typically a 1 to 3 night stay with return to normal activity in 2 to 4 weeks.

  4. 04 Aftercare

    Know your replacement plan

    If a cortisol-secreting tumour has been removed, you may need steroid cover for months - carry a steroid card and know sick-day rules.

Frequently asked

Everything we get asked about benign adrenal tumours.

Quick answers on incidentalomas, functioning tumours, biopsy risks and adrenalectomy.

  • What is a benign adrenal tumour?

    Any non-cancerous growth in one of the adrenal glands. The commonest is a non-functioning cortical adenoma, but the group also includes cortisol, aldosterone and catecholamine-secreting tumours, myelolipomas, adrenal cysts and ganglioneuromas.

  • Should every adrenal incidentaloma be investigated?

    Yes. Current European Society of Endocrinology guidance recommends hormonal screening for every incidentally found adrenal lesion - a 1 mg overnight dexamethasone suppression test, plasma or urinary metanephrines and, in patients with hypertension or low potassium, an aldosterone to renin ratio.

  • When does a benign adrenal tumour need surgery?

    Surgery is recommended for any functioning tumour that is secreting hormone, for lesions larger than 4 cm, for lesions with suspicious imaging features, and for tumours that grow on follow-up. Laparoscopic adrenalectomy is the preferred approach when the lesion is benign, under 6 to 8 cm and shows no invasion.

  • Is a biopsy of the adrenal gland ever needed?

    Rarely. Percutaneous biopsy risks seeding cancer, causing bleeding and provoking a life-threatening catecholamine crisis if the lesion is an unrecognised phaeochromocytoma. It is only considered when metastatic disease is strongly suspected and after phaeochromocytoma has been excluded biochemically.

  • How is a phaeochromocytoma prepared for surgery?

    With 10 to 14 days of alpha-blockade using phenoxybenzamine or doxazosin, followed by cautious beta-blockade if needed. The aim is to control blood pressure and prevent a catecholamine surge during induction of anaesthesia.

  • How long is follow-up after finding a benign adrenal tumour?

    For a non-functioning adenoma under 4 cm with benign imaging features, ESE guidance suggests repeat imaging and hormones at 6 to 12 months, then periodic review out to 3 to 5 years. Stable, clearly benign lesions can then be discharged.

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