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An adrenal incidentaloma is an important clinical finding that is often considered harmless, but can be the tip of the iceberg. The term incidentaloma indicates an adrenal mass larger than 1 cm, incidentally discovered during imaging studies performed for reasons other than suspicion of adrenal pathology. Lesions identified during staging procedure or work-up for patients with a known extra-adrenal malignancy are not considered to be an incidentaloma (Young, Jr. 2000; Grumbach et al. 2003; Young, Jr. 2007; Singh & Buch 2008; Terzolo et al. 2009; Androulakis et al. 2011). The entity incidentaloma is not a new finding and has been reported for many years (Grumbach et al. 2003; Young, Jr. 2007; Singh & Buch 2008; Terzolo et al. 2009; Androulakis et al. 2011). Because of the increased use of imaging techniques and improvement in abdominal imaging, the frequency of incidentaloma findings is increasing as well. Recent studies using high-resolution computed tomography (CT) have reported an estimated prevalence of 4% (Young, Jr. 2007; Singh & Buch 2008). In autopsy studies the prevalence ranged 0.2%-8.7%, depending on definitions used and age group, as there is an agedependent occurrence of adrenal incidentalomas (Young, Jr. 2000; Grumbach et al. 2003; Young, Jr. 2007; Singh & Buch 2008; Terzolo et al. 2009; Androulakis et al. 2011). The estimated prevalence in patients younger than 30 years is < 1%, in contrast to a 7% frequency in patients 70 years of age or older (Young, Jr. 2007). With an aging population and advanced radiological techniques becoming more widely available, the increasing frequency of adrenal incidentalomas is of growing importance. When an incidentaloma is found, it is of vital importance to make an early and reliable differentiation between benign and (potentially) malignant lesions, but also to assess tumor functionality. The mass can originate from either the adrenal medulla or cortex (Androulakis et al. 2011). Consequently, a spectrum of different pathological conditions may underlie an incidentaloma, all requiring a different therapeutic approach. As much as 38 different diagnoses have been reported in patients with a serendipitous discovered adrenal tumor (Young, Jr. 2000). Most adrenal incidentalomas are clinically nonhypersecretory benign adenomas, with an estimated frequency of 70-80%, which cause no health problems. However, in 5-20% of patients who have no endocrinological signs or symptoms, analysis reveals subclinical hypercortisolism (Grumbach et al. 2003; Young, Jr. 2007; Singh & Buch

Adrenal Incidentaloma and Adrenocortical Carcinoma: A Clinical Guideline on Treating the Unexpected and a Plea for Specialized Care