What is the treatment for a nonfunctional adrenal mass?

• A. Lesions smaller than 4 cm observed; 4-6 cm resected if risk acceptable; >6 cm resected
• B. Immediate surgical resection for all nonfunctional lesions
• C. Radiotherapy is the treatment of choice
• D. No follow-up imaging is needed

Answer: (A)

Managing a nonfunctional adrenal mass revolves around the risk of cancer as the lesion grows. When the mass is under 4 cm and imaging suggests a benign appearance, watching it with periodic imaging is appropriate rather than rushing to surgery. If the lesion is in the 4–6 cm range, resection is considered if the patient can tolerate surgery, because the likelihood of malignancy increases with size. For masses larger than 6 cm, surgical removal is typically recommended regardless of functional status due to a higher risk of adrenocortical carcinoma. Radiotherapy isn’t the treatment of choice for these lesions, and avoiding follow-up imaging after initial assessment isn’t advisable if you’re observing a lesion. It’s also important to confirm there’s no subclinical hormone excess before deciding on observation, since a functional tumor would steer management differently.