{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:13:46Z","timestamp":1789578826275,"version":"build-2803163510"},"reference-count":22,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The prevalence of adrenal incidentalomas is increasing substantially with cross-sectional imaging, with reported prevalence from 1% to 5% on computed tomography and up to 8.7% at autopsy. While the majority of incidentalomas are benign nonfunctional adenomas, clinicians face the critical challenge of identifying the rare adrenocortical carcinoma (0.5\u20132 per million annually), which carries an extremely poor prognosis with 5-year survival of only 50% and &lt;15% if metastatic. Functioning adrenal tumors occur in 27.5% of incidentalomas, including mild autonomous cortisol secretion (MACS) in 5%\u201330%, primary aldosteronism in 5%\u20136%, and pheochromocytomas in 4%\u20138%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Comprehensive literature review of current evidence on adrenal incidentaloma management incorporating a systematic three-pillar diagnostic framework is presented: (1) imaging assessment based on Hounsfield unit attenuation and contrast washout, (2) comprehensive hormonal testing for cortisol excess, aldosterone excess, and pheochromocytoma, and (3) growth assessment over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A three-pillar diagnostic approach effectively stratifies adrenal incidentaloma management. Imaging: lesions with Hounsfield units &lt;10 are benign (0% malignancy risk), 10\u201320 are indeterminate (0.5% risk), and &gt;20 are suspicious (6.3% risk), both warranting comprehensive evaluation. Hormonal evaluation: MACS is diagnosed by a positive 1-mg dexamethasone suppression test for cortisol without clinical Cushing features; overt Cushing presents with markedly elevated cortisol, suppressed ACTH, and characteristic clinical stigmata. Primary aldosteronism with an aldosterone-to-renin ratio of &gt;30 requires confirmatory testing. Pheochromocytoma diagnosis requires plasma-free metanephrines. A growth rate of &gt;0.8 cm\/year predicts malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Comprehensive evaluation incorporating imaging characterization, hormonal testing, and growth surveillance provides an evidence-based framework for safe management of adrenal incidentalomas. Recent randomized controlled trials support expanded surgical indications in carefully selected MACS patients, particularly those with documented comorbidities, demonstrating superior cardiovascular and metabolic outcomes compared with medical management alone. The paradigm has shifted from treating secondary comorbidities medically to addressing the underlying autonomous cortisol production surgically. Minimally invasive adrenalectomy remains the gold standard surgical approach in experienced hands.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10926429261443897","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T02:03:37Z","timestamp":1776996217000},"page":"511-516","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Management Approach of Adrenal Incidentaloma"],"prefix":"10.1177","volume":"36","author":[{"given":"Majd","family":"Kabbani","sequence":"first","affiliation":[{"name":"Department of General and Endocrine Surgery, Utica Park Clinic\/Hillcrest Hospital South, Tulsa, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eren","family":"Berber","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.3544"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-18-0608"},{"key":"e_1_3_2_4_2","first-page":"204062232110331","article-title":"Adrenocortical carcinoma: Current state of the art, ongoing controversies, and future directions in diagnosis and treatment","volume":"9","author":"Shariq OA","year":"2021","unstructured":"Shariq OA, , McKenzie TJ. Adrenocortical carcinoma: Current state of the art, ongoing controversies, and future directions in diagnosis and treatment. SAGE Open Med, 2021; 9:20406223211033103.","journal-title":"SAGE Open Med"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30314-4"},{"issue":"3","key":"e_1_3_2_6_2","first-page":"W143","article-title":"Incidental adrenal lesions: Prevalence and clinical significance in different age groups","volume":"190","author":"Boland GW","year":"2008","unstructured":"Boland GW, , Blake MA, , Hahn PF, et al. Incidental adrenal lesions: Prevalence and clinical significance in different age groups. 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Best Pract Res Clin Endocrinol Metab, 2020; 34(2):101367.","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13244-025-02015-4"},{"issue":"8","key":"e_1_3_2_11_2","first-page":"4329","article-title":"CT imaging characteristics and washout thresholds for adrenal adenoma identification","volume":"30","author":"Tormanen A","year":"2020","unstructured":"Tormanen A, , Boulanger AC, , Willems SM, et al. CT imaging characteristics and washout thresholds for adrenal adenoma identification. Eur Radiol, 2020; 30(8):4329\u20134338.","journal-title":"Eur Radiol"},{"issue":"6","key":"e_1_3_2_12_2","first-page":"1523","article-title":"Prevalence of functioning adrenal incidentalomas: A systematic review and meta-analysis","volume":"108","author":"Pereira AM","year":"2023","unstructured":"Pereira AM, , Rexach JA, , Senanayake PA, et al. Prevalence of functioning adrenal incidentalomas: A systematic review and meta-analysis. 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