Management of Adrenal Incidentalomas: A Survey of Physicians from the Middle East and Africa. Section Original articles

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Published Jan 22, 2026
https://doi.org/10.62438/tunismed.v103i11.5677
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Vol. 103 No. 11 (2025): Tunis Med Nov 2025

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Salem A Beshyah
Department of Medicine, Dubai Medical College, Dubai, Department of Endocrinology, Bareen International Hospital (NMC-MBZ), MBZ City, Abu Dhabi, UAE
Khadija Hafidh
Department of Medicine, Dubai Medical College, Dubai, Department of Endocrinology, Rashid Hospital, Dubai, UAE.
Dima K Abdelmannan
Department of Medicine, Dubai Medical College, Dubai, . Department of Postgraduate Medical Education, Dubai Academic Health Corporation, Dubai, UAE.
Omar Dhaimat
Department of Endocrinology, Clemenceau Medical Center and Hospital, Dubai, UAE
Melika Chihaoui
Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
Ian L Ross
Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

Abstract

Introduction: Adrenal incidentaloma (AI) is a common finding from increased imaging use. Several guidelines direct evaluation and management, but limited data exist on real-world practices.


Aim: To describe the knowledge and practices of physicians from the Middle East and Africa (MEA) in AI.


Methods: An online survey evaluated the definition of AI, diagnostic investigations, management approach, and long-term follow-up of patients with AI.


Results: 171 questionnaires were analysed. Adult and pediatric endocrinologists represented 71.4% of participants. A homogenous mass, < 4 cm and < 10HU, was considered benign by 57.9% of the respondents. The threshold of 4 cm for tumor size was considered suggestive of malignity by 64%. A minority, 34 (19.9%), indicated that no further imaging was required if a non-contrast CT scan was consistent with a benign adrenal mass. Most important endocrinopathies would routinely be excluded: hypercortisolism (97.7%), pheochromocytoma (95.3%), and primary hyperaldosteronism (87.1%). In a lesion considered biochemically inactive at the outset, 56.4% of the respondents would have recommended repeated biochemical testing, and 42.8% would have followed up the patients for 4 and 5 years, irrespective of radiological features.


Conclusions: There is an under-appreciation of the risk of malignancy of AI > 4 cm and a tendency of over-investigating patients in whom a benign tumor has been established, with repeated unnecessary biochemical and radiological evaluation, revealing sub-optimal adherence to guidelines regarding AI in this region.

Keywords:

adrenal incidentaloma, guidelines, guideline adherence, adrenocortical carcinoma, Cushing syndrome, pheochromocytoma

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