An adrenal nodule found unexpectedly on a scan is often benign, but it needs a structured review. The important questions are whether it produces excess hormones, whether its imaging appearance is clearly benign and whether any follow-up is required. The word "incidental" describes how it was found; it does not finish the assessment.
For someone who arranged a scan between work commitments, an unexpected finding can leave more uncertainty than the scan resolved. A useful next step is to bring the complete report and previous images to a clinician, rather than booking another whole-body scan without knowing what needs clarification.
Which tests and follow-up does an adrenal nodule need?
The adrenal glands sit above the kidneys and produce hormones involved in blood pressure, metabolism and the body's stress response. An incidentaloma is a mass found on imaging performed for another reason. Many are adrenal adenomas, which are benign growths. The European Society of Endocrinology's patient information explains that the great majority of incidentalomas are benign. [1]
However, a finding discovered during investigation of an existing cancer may require a different approach from an unexpected nodule in someone without a cancer history. Age, symptoms, previous imaging and the scan's technical details all matter. An internet summary cannot classify your individual lesion.
Ask The Wellness about a scan-results review if your report names an adrenal nodule without a clear onward plan. Send the whole report and any relevant previous scans.
Why do the CT details matter so much?
A radiologist looks at the lesion's density, uniformity, size and other features. On an unenhanced CT, density is described in Hounsfield units, often abbreviated to HU. The 2023 European guideline states that a homogeneous adrenal mass with unenhanced density of 10 HU or less has clear benign imaging features and does not need further imaging on that basis. [2]
That statement has precise conditions. It cannot be applied to a number measured after contrast, a heterogeneous lesion or a report that does not describe the necessary characteristics. A larger or indeterminate lesion may need dedicated imaging or multidisciplinary discussion. Size alone is not the entire decision.
Ask the reviewing clinician whether the original images are enough. Sometimes a radiology review of an existing scan is more helpful than repeating it with the wrong protocol.
Can a benign-looking nodule still produce hormones?
Yes. The imaging question and the hormone question are related but different. A benign adenoma can produce excess cortisol or other hormones. The assessment therefore considers symptoms, blood pressure and appropriate biochemical testing, not simply whether the scan looks reassuring. [1,2]
The European guideline recommends an overnight dexamethasone suppression test to assess autonomous cortisol secretion, with exceptions where testing would not be appropriate, such as some frail patients with limited life expectancy. This is a clinician-arranged test with specific instructions, not a reason to take steroid tablets independently. [2]
A random cortisol result or a consumer "stress test" is not an equivalent assessment. Tell the clinician about all steroid exposure, including tablets, injections, inhalers and creams, because medicines can affect interpretation.
Does everyone need the same hormone panel?
No. Tests depend on the imaging and clinical picture. The guideline recommends checking for phaeochromocytoma with plasma or urine metanephrines when the lesion does not have typical benign adenoma features. People with hypertension or unexplained low potassium may need an aldosterone-renin assessment. [2]
Preparation and current medicines can affect these tests. Do not stop blood-pressure treatment yourself to prepare for an appointment. Ask the responsible service for a written testing plan and tell them about medicines prescribed by other clinicians.
What is mild autonomous cortisol secretion?
This term, often shortened to MACS, describes cortisol production that is not appropriately suppressed in testing, without the clinical picture of overt Cushing's syndrome. A result is interpreted with the test conditions, other findings and relevant health problems. It is not a diagnosis made from the nodule's appearance alone. [2]
Management can include assessment of conditions such as blood pressure or diabetes and a discussion of whether surgery is appropriate in an individual case. The guideline does not recommend automatic surgery for every mildly abnormal test. Age, general health, associated conditions and personal preference matter, with specialist input.
Will you need another scan every year?
Not necessarily. The 2023 guideline recommends against routine further imaging when the lesion has clear benign features. Indeterminate lesions and particular clinical situations have different pathways. Repeated scans without a reason can add cost, incidental findings and, for CT, radiation exposure. [2]
A good plan should state whether follow-up is needed, why, which scan or test is intended and who will review it. If no further imaging is recommended, ask for the explanation in writing so another service does not restart surveillance simply because it lacks the original report.
When should you seek care urgently?
Severe headache with chest pain, collapse, marked palpitations or severe acute illness needs urgent medical assessment. Do not assume an adrenal finding explains it or wait for a routine endocrine appointment. New symptoms and rapidly changing health should be assessed on their own merits.
Tell the reviewing clinician if you are pregnant, have a known cancer or have developed significant new symptoms. These circumstances can alter the investigation pathway and its urgency.
What should you bring to a review?
Bring the current report, image-access details, any prior abdominal imaging, your medicine list and a short symptom history. Include home blood-pressure readings if available. If testing has already been done abroad, include units, reference ranges and the exact test protocol, rather than a summary saying "hormones normal".
Contact The Online GP, part of The Wellness, to discuss an appropriate review and any endocrine referral. Confirm the consultation and onward-investigation fees before booking. The value is an organised answer to a specific finding, not the largest available screening package.
Questions patients often ask
Is an incidentaloma a cancer diagnosis? No. Most are benign, but the report needs appropriate interpretation.
Does normal cortisol exclude every hormone problem? No. The type of test and the clinical question matter.
Should I book an adrenal biopsy? Not independently. Biopsy has a limited role and requires specialist assessment; some hormone-producing lesions must be excluded before considering an invasive procedure. [2]
Can the original scan be reviewed without repeating it? Sometimes. Ask whether the actual images and their protocol answer the question before paying for another investigation.
Arrange a scan-results consultation or ask the team about the right route. This guide is educational and cannot determine the nature of a particular adrenal mass.
Ask the team on WhatsApp, call +44 20 3951 3429 or email team@thewellnesslondon.com to discuss an appropriate consultation.
For a separate discussion of broader prevention, The Wellness executive programmes are published at £34,995, £14,995 and £6,995 as of 31 October 2026. These are programme prices, not fees for investigating this finding. A focused consultation or indicated specialist assessment may be the right next step instead.
Evidence and further reading
- European Society of Endocrinology. Information for individuals with adrenal incidentalomas. Patient guidance on imaging and hormone assessment.
- European Society of Endocrinology clinical practice guideline on adrenal incidentalomas, 2023. Full guideline available here. Recommendations distinguish clear benign imaging, indeterminate lesions and hormone excess.
Evidence checked 31 October 2026. This article summarises current guideline principles, not a personalised surveillance schedule.
Contact The Online GP with your complete report to arrange an appropriate review.