Update of the guidelines on the management of adrenal incidentaloma from the adrenal group of the Spanish society of endocrinology and nutrition (SEEN).

introductionAdrenal incidentalomas (AIs) are one of the most common reasons for consultation in endocrinology clinics, with their incidence rising over the last two decades.

methodsThis article updates the SEEN guideline for managing AIs (published in 2020) and highlights changes in diagnosis and follow-up recommendations.

resultsAIs are one of the most frequent reasons for consultation in Endocrinology, and when they are detected, two important aspects should be evaluated: hormonal functionality and potential malignancy. The most frequent hormonal alteration in these patients is mild autonomous cortisol secretion (MACS), while pheochromocytoma, overt Cushing´s syndrome or primary aldosteronism represent less than 10% of the causes of AIs. For this reason, a 1mg dexamethasone suppression test (DST) is recommended in the majority of patients with AIs. Non contrast CT is considered the imaging modality of choice for differentiating between benign and malignant AIs. Adrenalectomy remains the gold standard treatment in case of radiological suspicion of malignancy or tumors associated with overt hormonal syndromes.

conclusionTwo aspects should be evaluated when an AI is detected: functionality and malignancy. MACS is the most frequent hormonal alteration and is associated with an increased morbidity and mortality. For the differential diagnosis between benign and malignant, non-contrast CT is considered the imaging modality of choice. Adrenalectomy is the treatment of choice for malignant adrenal lesions or those associated with overt hormonal syndromes.