Kouroglou E, Tsiama V, Stroumpouli E, Savvidis C, Kallistrou E, Ragia D, Motsiou D, Proikaki S, Belis K, Ilias I. Evaluation of adrenal incidentalomas: Current approaches, caveats, and unexplored issues. World J Radiol 2026; 18(4): 119833 [DOI: 10.4329/wjr.v18.i4.119833]
Corresponding Author of This Article
Ioannis Ilias, MD, PhD, Department of Endocrinology, Hippocration General Hospital, No. 63 Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Apr 28, 2026 (publication date) through Apr 24, 2026
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Journal Information of This Article
Publication Name
World Journal of Radiology
ISSN
1949-8470
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Kouroglou E, Tsiama V, Stroumpouli E, Savvidis C, Kallistrou E, Ragia D, Motsiou D, Proikaki S, Belis K, Ilias I. Evaluation of adrenal incidentalomas: Current approaches, caveats, and unexplored issues. World J Radiol 2026; 18(4): 119833 [DOI: 10.4329/wjr.v18.i4.119833]
Eleni Kouroglou, Vasiliki Tsiama, Christos Savvidis, Efthymia Kallistrou, Dimitra Ragia, Dimitra Motsiou, Stella Proikaki, Konstantinos Belis, Ioannis Ilias, Department of Endocrinology, Hippocration General Hospital, Athens GR-11527, Greece
Evaggelia Stroumpouli, Department of Radiology, Hippokration General Hospital, Athens GR-11527, Greece
Author contributions: Kouroglou E, Tsiama V, Stroumpouli E, Savvidis C, Kallistrou E, Ragia D, Motsiou D, Proikaki S, Belis K, and Ilias I searched the literature and drafted this work. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ioannis Ilias, MD, PhD, Department of Endocrinology, Hippocration General Hospital, No. 63 Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com
Received: February 7, 2026 Revised: March 3, 2026 Accepted: April 8, 2026 Published online: April 28, 2026 Processing time: 76 Days and 14.6 Hours
Core Tip
Core Tip: Incidental adrenal masses are increasingly identified through modern imaging, and physicians must differentiate benign from malignant lesions while excluding hormonal hypersecretion. Mild autonomous cortisol secretion is common and carries cardiometabolic/skeletal risks, warranting biochemical evaluation. Current evidence supports a conservative radiologic approach: Homogeneous adrenal lesions with non-contrast computed tomography attenuation ≤ 10 Hounsfield units are considered benign, and emerging data suggest this threshold may safely extend to ≤ 20 Hounsfield units. The utility of adrenal washout computed tomography is increasingly questioned due to its poor discrimination of pheochromocytoma and limited cost-effectiveness. Future research should address psychiatric consequences and novel etiological factors.
