Objectives. The aim of this study was to investigate the detection rate of adrenal incidentalomas and subsequent workup. Design. Retrospective cohort study. Methods. Two investigators evaluated the adrenals on abdominal CT scans. Abnormalities were compared to the original radiology reports and an experienced abdominal radiologist reviewed the CT scans. All additional imaging and laboratory tests were assessed. Results. The investigators detected 44/356 adrenal incidentalomas (12%). In 25 patients an adrenal incidentaloma had been noted in the radiology report. The expert radiologist agreed on 19 incidentalomas in 17 patients, two with bilateral incidentalomas. Of the 25 incidentaloma patients, 4 (16%) patients were screened for hormonal overproduction and 2 (8%) patients had follow-up imaging studies. Conclusions. 12% of the patients had an adrenal incidentaloma (42 of 356). 17 (40%) had initially not been reported by the radiologist. When diagnosed with an adrenal incidentaloma, only a small percentage of patients (16%) is screened or undergoes repeated imaging (8%) as proposed in the National Institutes of Health (NIH) guidelines on adrenal incidentalomas. 1. Introduction An adrenal incidentaloma is an adrenal mass, larger than 1？cm in diameter, detected on imaging studies performed for other indications than adrenal disease [1, 2]. The increasing use of computed tomography (CT) scans and magnetic resonance imaging (MRI) causes a marked increase in incidence of adrenal incidentalomas [3]. In approximately 6% of all autopsies and 4% of all abdominal CT scans an incidentaloma of the adrenal gland is discovered [4, 5]. The incidence of adrenal incidentaloma increases with age to an incidence of 10% in patients over 70 years old. Adrenal incidentalomas are characterized by size, growth, imaging characteristics, and functional status. Although rare, the normal function of the adrenal gland can be disrupted by adrenal incidentalomas. In most cases adrenal incidentalomas will be a small, nonhormonal active cortical adenoma, a benign impediment (80%). Some adrenal incidentalomas cause hormonal hypersecretion (15%) or appear to be a primary or secondary malignancy (<5%) [6, 7]. Adrenal incidentalomas can cause disease by hypersecretion of hormones. Conditions due to hormonal activity of adrenal incidentaloma include hypercortisolism, (Cushing’s syndrome), catecholamine excess (pheochromocytoma), or hyperaldosteronism (Conn’s Syndrome) [8]. Subclinical autonomous cortisol hypersecretion is the most frequent hormonal abnormality in patients with adrenal
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