Management of an Asymptomatic, Nonfunctioning Unilateral Adrenal Mass with Benign CT Features

When an adrenal mass is detected incidentally, is completely asymptomatic, produces no hormonal excess, and shows clearly benign characteristics on imaging, a specific evidence-based approach applies — one that differs markedly from how a suspicious or functional lesion would be handled.

Clinical scenario: Asymptomatic unilateral adrenal mass that is nonfunctioning — no evidence of adrenal hormone excess — with a homogeneous appearance on imaging and unenhanced CT Hounsfield units (HU) ≤ 10, indicating obvious benign features.

For this presentation, the evidence-based approach is conservative and non-interventional. The full protocol specifies what the recommended course of action entails, including whether any further steps are indicated.

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References

DOI: 10.1093/ejendo/lvad066

We recommend against performing surgery in patients with an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies.

We recommend that if the noncontrast CT is consistent with a benign adrenal mass (homogenous appearance and HUs ≤ 10) no further imaging is required.

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