Adrenal Incidentaloma: What It Is, When to Worry, and What Doctors Look For

When a scan for back pain, a stomach issue, or even a routine checkup turns up a lump on your adrenal gland, a small, triangular organ sitting on top of each kidney that produces hormones like cortisol and adrenaline. This unexpected find is called an adrenal incidentaloma. Most of the time, it’s not cancer, and it’s not causing symptoms—but that doesn’t mean you can ignore it.

Adrenal incidentalomas are found in about 4% of people who get abdominal scans, and that number goes up with age. The real question isn’t just whether it’s there, but whether it’s making too much hormone. Some tumors overproduce cortisol, leading to weight gain, high blood pressure, and mood swings. Others pump out excess aldosterone, which spikes blood pressure and drains potassium. Then there are those that make adrenaline-like chemicals, causing panic attacks, sweating, and racing heartbeats—even when you’re calm. If your tumor does any of this, it’s not just a bump. It’s a signal your body’s chemistry is off. That’s why doctors don’t just look at size. They test your blood and urine for hormone levels, and they track how the tumor changes over time.

Size matters too. Tumors under 4 cm are usually watched with repeat scans every 6 to 12 months. Anything bigger than 4 cm, or one that grows fast, gets more attention—because while most are benign, bigger ones have a higher chance of being cancerous. You might also hear terms like hormone imbalance, a disruption in how your body makes or uses stress and metabolic hormones, or adrenal tumor, a growth on the adrenal gland that can be non-cancerous or malignant. These aren’t just medical jargon. They’re clues your body gives you when something’s out of sync.

What you won’t find in most articles is how often people panic over these findings—and how often they don’t need surgery at all. Many adrenal incidentalomas are harmless fat deposits or benign growths that never cause trouble. But skipping follow-up? That’s risky. The key is knowing which tests to ask for, what numbers to track, and when to push for a second opinion. Below, you’ll find real cases, common mistakes, and clear comparisons of how doctors decide what to do next. This isn’t about fear. It’s about knowing what to watch for—and when to act.