How is the lesion treated?

This depends on what lesion is found and is essentially the same as that used for adrenal masses that would have presented directly and not incidentally. The principles of treatment are as follows:

• Any benign tumours that are causing problems or may potentially cause problems can be removed, usually by laparoscopic (keyhole) surgery. Tumours > 3cm tend to fall into this category.
• Malignant tumours may be excised for palliative reasons but surgery (always done as an open operation) is unlikely to be curative.
• Medical therapy may be considered for functioning lesions best treated by drugs (e.g. spironolactone used for bilateral Idiopathic Adrenal Hyperplasia producing primary hyperaldosteronism, or hormone replacement for Congenital Adrenal Hyperplasia).

Obviously follow up of any identified lesions is essential to ensure nothing sinister develops. If the tumour grows more than 50% of its original size this is an indication for surgery.