{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T13:20:11Z","timestamp":1794057611459,"version":"4.8.0"},"reference-count":291,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T00:00:00Z","timestamp":1686787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010382","name":"European Society of Endocrinology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010382","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Network for the Study of Adrenal Tumors"},{"name":"COST Action \u201cHarmonizing clinical care and research on adrenal tumours in European countries"},{"DOI":"10.13039\/501100000921","name":"European Cooperation in Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Adrenal incidentalomas are adrenal masses detected on imaging performed for reasons other than suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas but may also require therapeutic intervention including that for adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastases. Here, we provide a revision of the first international, interdisciplinary guidelines on incidentalomas. We followed the Grading of Recommendations Assessment, Development and Evaluation system and updated systematic reviews on 4 predefined clinical questions crucial for the management of incidentalomas: (1) How to assess risk of malignancy?; (2) How to define and manage mild autonomous cortisol secretion?; (3) Who should have surgical treatment and how should it be performed?; and (4) What follow-up is indicated if the adrenal incidentaloma is not surgically removed?<\/jats:p>\n                  <jats:p>Selected Recommendations: (1) Each adrenal mass requires dedicated adrenal imaging. Recent advances now allow discrimination between risk categories: Homogeneous lesions with Hounsfield unit (HU) \u2264 10 on unenhanced CT are benign and do not require any additional imaging independent of size. All other patients should be discussed in a multidisciplinary expert meeting, but only lesions &amp;gt;4\u2005cm that are inhomogeneous or have HU &amp;gt;20 have sufficiently high risk of malignancy that surgery will be the usual management of choice. (2) Every patient needs a thorough clinical and endocrine work-up to exclude hormone excess including the measurement of plasma or urinary metanephrines and a 1-mg overnight dexamethasone suppression test (applying a cutoff value of serum cortisol \u226450\u2005nmol\/L [\u22641.8\u2005\u00b5g\/dL]). Recent studies have provided evidence that most patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post dexamethasone &amp;gt;50\u2005nmol\/L (&amp;gt;1.8\u2005\u00b5g\/dL) harbor increased risk of morbidity and mortality. For this condition, we propose the term \u201cmild autonomous cortisol secretion\u201d (MACS). (3) All patients with MACS should be screened for potential cortisol-related comorbidities that are potentially attributably to cortisol (eg, hypertension and type 2 diabetes mellitus), to ensure these are appropriately treated. (4) In patients with MACS who also have relevant comorbidities surgical treatment should be considered in an individualized approach. (5) The appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health, and patient preference. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. (6) Surgery is not usually indicated in patients with an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. Furthermore, we offer recommendations for the follow-up of nonoperated patients, management of patients with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses, and for young and elderly patients with adrenal incidentalomas. Finally, we suggest 10 important research questions for the future.<\/jats:p>","DOI":"10.1093\/ejendo\/lvad066","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T09:19:55Z","timestamp":1686820795000},"page":"G1-G42","source":"Crossref","is-referenced-by-count":826,"title":["European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6170-6398","authenticated-orcid":false,"given":"Martin","family":"Fassnacht","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of W\u00fcrzburg , W\u00fcrzburg , Germany"},{"name":"Comprehensive Cancer Center Mainfranken, University of W\u00fcrzburg , W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stylianos","family":"Tsagarakis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital , Athens , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4171-2851","authenticated-orcid":false,"given":"Massimo","family":"Terzolo","sequence":"additional","affiliation":[{"name":"Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin , Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1231-3306","authenticated-orcid":false,"given":"Antoine","family":"Tabarin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and nutrition, University and CHU of Bordeaux , Bordeaux , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anju","family":"Sahdev","sequence":"additional","affiliation":[{"name":"Department of Imaging, St Bartholomew's Hospital, Barts Health , London, EC1A 7BE , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Newell-Price","sequence":"additional","affiliation":[{"name":"Department of Oncology and Metabolism, Medical School, University of Sheffield , Sheffield, S10 2RX , United Kingdom"},{"name":"Department of Endocrinology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , S10 2JF , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4956-4037","authenticated-orcid":false,"given":"Iris","family":"Pelsma","sequence":"additional","affiliation":[{"name":"Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Centre , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ljiljana","family":"Marina","sequence":"additional","affiliation":[{"name":"Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade , Belgarde, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0281-1950","authenticated-orcid":false,"given":"Kerstin","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg , Halle (Saale) , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-2524","authenticated-orcid":false,"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, Nutrition and Diabetes, Mayo Clinic , Rochester, MN , United 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