Recognize the appropriate management of an incidental adrenal tumor.

Explanation:   

All incidentalomas whether in the adrenal or any other endocrine site - must be evaluated for hyperfunction before biopsy. This is important because without proper preparation in an overacting gland, there is a high chance of triggering a storm.

The risk of tumors being malignant can be assessed by their hounsfield density - on a CT scan. If more than 10  then likelihood of malignancy is high. Do biopsy. If growth rate is high, do biopsy.

any a times an adrenal incidentaloma is presented in a case of NSCLC. In such cases, if the adrenal is the only suspected site of metastasis and the tumor is resectable, get a biopsy result of the adrenal mass before resecting the primary.

PET scan has changed this scenario and now a PET scan easily reveals the malignant nature of the incidentaloma. If PET scan is given as an option, choose it.