Curated insights • How it Works • Practical Pearls • Evidence Base
| Hounsfield Units (HU) | Size | Malignancy Risk | Recommendation |
|---|---|---|---|
| ≤ 10 HU | Any | Near 0% (Lipid-rich adenoma) | No further imaging needed |
| 11 - 20 HU | < 4 cm | Low | Repeat imaging in 6-12 months or consider washout protocol |
| > 20 HU | < 4 cm | Moderate | CT washout protocol or MRI chemical shift |
| Any (>10 HU) | ≥ 4 cm | High | Surgical consultation (Adrenalectomy) |
Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors
Never biopsy an adrenal mass without first ruling out Pheochromocytoma biochemically. Biopsy of a pheochromocytoma can cause catastrophic hypertensive crisis.