How to manage an adrenal incidentaloma in a hypertensive patient?

Abstract

An adrenal incidentaloma (AI) is a mass discovered on imaging that was not performed for suspected adrenal diseases. Technological advancements in imaging modalities that are widely available, a growing awareness of preventive care and an aging population, have led to an increase in the detection of adrenal incidentalomas, generating diagnostic and therapeutic dilemmas for clinicians. Every patient with an adrenal incidentaloma should undergo careful evaluation: 1) to establish the etiology of the tumor, 2) to detect all hormonally active lesions, including secondary forms of hypertension. Hormonal hypertension carries a higher risk of cardiovascular complications and target organ damage than essential hypertension, independently of blood pressure control. In this review, we discuss the current 2023 European Society of Endocrinology guidelines on the management of adrenal incidentalomas, in the context of other experts' documents (including Polish Society of Endocrinology recommendations), with the main focus on the two secondary forms of hypertension - primary aldosteronism and pheochromocytoma - that should not be missed in clinical practice.