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Most adrenal incidentalomas — adrenal masses found incidentally during imaging conducted for other reasons — are nonfunctioning adenomas. A small proportion are associated with subclinical Cushing syndrome (i.e., autonomous secretion of glucocorticoid but no clinical features of overt Cushing syndrome), and the remainder are functioning adenomas (i.e., causing overt Cushing syndrome or hyperaldosteronism) or pheochromocytomas.
In this meta-analysis of 32 studies that involved about 4000 patients, researchers examined the natural history of nonfunctioning adrenal adenomas (70% of cases), adenomas causing mild autonomous cortisol excess without overt Cushing syndrome (19%), and adenomas for which this distinction was not clearly reported (11%)…