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Understanding Your Results: An Adrenal Nodule Found on a CT Scan
You went in for a routine scan, maybe to check on back pain, look at your kidneys, or investigate an unrelated concern. If you recently had an adrenal nodule found on a CT scan, receiving that unexpected news can feel overwhelming.
If that happened to you, you’re not alone. Adrenal nodules, also called adrenal incidentalomas, are found in roughly 3 to 4 out of every 100 abdominal CT scans performed, and their discovery is almost always accidental. The word “incidentaloma” literally means a finding discovered by chance, not because your doctor was looking for it.
The good news: the vast majority of adrenal nodules are benign and do not require surgery. But every adrenal nodule does deserve a proper evaluation by an experienced specialist. Here is a clear, step-by-step guide to what happens next
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What Exactly Is the Adrenal Gland?
Your body has two adrenal glands, one sitting just above each kidney. They are small (about the size of a walnut), but they produce hormones that regulate some of your body’s most essential functions: your stress response (cortisol and adrenaline), blood pressure (aldosterone), and metabolism.
When a nodule forms on an adrenal gland, the key questions a specialist like Dr. Neychev will ask are: Is it producing excess hormones? Does it look suspicious for cancer on imaging? And based on all the evidence, does it need to come out?
Step 1: What it means to Have an Adrenal Nodule Found on a CT Scan.
The radiologist’s report will typically describe the nodule’s size (in centimeters), its density (measured in Hounsfield units or HU on a non-contrast CT), and its appearance. The density measurement is extremely important:
- A nodule measuring 10 HU or less on a non-contrast CT is almost certainly a benign, lipid-rich adenoma is the most common type. No further imaging is typically needed.
- A nodule measuring more than 10 HU requires additional evaluation, including specialized CT imaging with contrast washout measurements.
- A nodule larger than 4 cm warrants a surgical evaluation regardless of HU value, as size alone increases the risk of adrenocortical carcinoma (adrenal cancer).
Step 2: Biochemical Testing: Is the Nodule Making Hormones?
Even if a nodule looks completely benign on imaging, your doctor will order bloodwork and urine tests to determine if it is hormonally active. This evaluation typically screens for three conditions:
- Subclinical Cushing Syndrome: excess cortisol production, tested with a 1 mg overnight dexamethasone suppression test
- Pheochromocytoma: a tumor that secretes adrenaline-like hormones, tested with plasma or urine metanephrines, this must be ruled out before any biopsy or surgery
- Primary Aldosteronism (Conn Syndrome): excess aldosterone causing high blood pressure, tested with an aldosterone-to-renin ratio
The results of this hormonal workup, combined with the imaging characteristics, determine your treatment path.
Step 3: When Is Surgery Needed?
Surgery (laparoscopic adrenalectomy) is generally recommended when:
- The nodule is greater than 4 cm in diameter
- It is proven or strongly suspected to be a pheochromocytoma
- Imaging suggests malignancy (irregular borders, heterogeneous appearance, elevated HU)
- The nodule is causing overt hormonal excess (overt Cushing syndrome, primary aldosteronism with a unilateral source)
- The nodule grows significantly on follow-up imaging (typically more than 1 cm in 12 months
What If Surgery Is Not Needed?
Many adrenal nodules can be safely monitored with periodic imaging and repeat hormonal testing. The current European Society of Endocrinology guidelines (updated 2023) recommend follow-up imaging at 6–12 months for indeterminate nodules and annual reassessment of hormonal status for 4–5 years.
At UCF Health, Dr. Neychev works closely with our endocrinology team to provide coordinated monitoring plans for patients who do not need immediate surgery.
Why See a Fellowship-Trained Endocrine Surgeon?
The evaluation and management of adrenal incidentalomas requires a specialist who understands both the surgical and hormonal dimensions of the disease. Dr. Vladimir Neychev completed a two-year clinical and research fellowship in endocrine surgical oncology at the National Cancer Institute (part of the National Institutes of Health), where he developed expertise in the full spectrum of adrenal conditions, from benign adenomas to adrenocortical carcinoma.
As the only surgeon in the East Orlando and Lake Nona market with NIH endocrine surgery fellowship training, Dr. Neychev offers a level of subspecialty expertise that is otherwise only available in major academic medical centers like Tampa or Jacksonville.
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Frequently Asked Questions
No. The vast majority of adrenal nodules (more than 90%) are benign. Adrenocortical carcinoma (adrenal cancer) is rare. However, every nodule deserves proper evaluation to rule out malignancy and hormonal excess.
Generally, nodules larger than 4 cm are referred for surgical evaluation due to increased cancer risk. Smaller nodules may also need surgery if they are hormonally active or show features suspicious for malignancy on imaging.
Most patients who undergo laparoscopic adrenalectomy return to desk work within 1–2 weeks. Recovery from minimally invasive adrenal surgery is significantly faster than open surgery.
Request a copy of your imaging report and bring it to a consultation with Dr. Neychev. Older findings still warrant evaluation, especially if you have unexplained symptoms like high blood pressure, weight changes, or fatigue.
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- adrenal nodule CT Scan Endocrine Surgery health healthy living High Aldosterone high cortisol Pheochromocytoma surgery