What is the role of functional studies in the evaluation of adrenal incidentaloma?

A 22-year-old female comes with an incidentally detected mass in the right adrenal gland of 2 cm size detected during a CT scan done for abdominal pain. She has no hypertension, no cushingoid features and no virilization. She has no family history of multiple endocrine neoplasia. She has no history of renal calculi. The cause of abdominal pain is finally diagnosed as abdominal migraine. How will you evaluate this case of adrenal incidentaloma? An adrenal “incidentaloma” is an adrenal mass, generally 1 cm or more in diameter that is discovered ‘incidentally’ during a radiologic examination performed for indications other than an evaluation for adrenal disease. The definition of incidentaloma excludes patients undergoing imaging procedures as part of staging and work-up for cancer and patients with symptomatic adrenal disease not elicited due to oversight. Adrenal incidentaloma is not a single entity; rather it is an ‘umbrella’ defini-tion comprising a spectrum of different pathological entities that share the same path of discovery. The widespread use of computed tomography (CT), diagnostic ultrasound, and magnetic resonance imaging (MRI) has resulted in the frequent incidental discovery of asymptomatic adrenal masses. The optimal diagnostic approach to a patient who has an adrenal incidentaloma is by taking a careful history and performing a physical examination, focusing on the signs and symptoms suggestive of adrenal hyperfunction or malignant disease followed by hormonal testing, when indicated. The two important questions to be answered at the end of evaluation are:  • Does the patient have a lesion suggestive of malignancy?  • Is the lesion hormonally active?  • Do you want any further information from the CT scan done?

What is the role of functional studies in the evaluation of adrenal incidentaloma?