What is the management of adrenal incidentaloma?

A 42-year-old woman is subjected to computed tomography (CT) scan of the abdomen for recurrent complaints of epigastric discomfort which revealed a 2.6 cm × 2 cm × 3 cm well rounded mass in her left adrenal gland, with a attenuation value of 5 HU, well enhancing on contrast administration. Washout study is not done. She was diagnosed with hypertension and diabetes since 2 years for which she is on amlodipine 5 mg/day and metformin 2 g/day. She has progressively gained weight since the birth of her last child birth ten years ago and currently is obese with a BMI 28 kg/m2. Her menstrual cycles are irregular since 5 years and bleeds every 2 months only after ingestion of a pill taken twice daily for a week. On examination, central obesity is present, supraclavicular areas are full. Skin appears normal with no thinning, bruising or striae. No proximal myopathy or hirsutism is noted.

Management: The imaging characteristics indicate a benign lesion. Her clinical profile validates screening for pheochromocytoma, Cushing’s syndrome and primary hyperaldosteronism. All her tests are negative. She is advised to follow-up every 6 months with repeat imaging and biochemical testing.

What is the management of adrenal incidentaloma?