Diagnosis
Due to their asymptomatic nature, most reported cases of adrenal adenomas have been discerned fortuitously through autopsy, or during medical imaging, particularly CT scan (computed tomography) and magnetic resonance imaging. Hence, they have earned the title incidentaloma referring to small adenoma discovered incidentally. Though adrenocortical adenomas are considered challenging to differentiate from the normal adrenal cortex, they appear as well-circumscribed lesions once isolated.Imaging Diagnostics

Computed Tomography (CT scan)
Magnetic Resonance Imaging (MRI)
Laboratory Tests

CRH Stimulation Test
High-dose-dexamethasone suppression test

Gross Description
Well-circumscribed lesion
Size ≤ 5 cm
Weight ≤ 50 grams
often appear as golden-yellow color mass(may have focal dark regions corresponding to hemorrhage, lipid-depletion, and increased lipofuscin)

Histopathology
The microscopic histopathology analysis of the tissue samples obtained from the adrenal cortex of individuals presenting with adenoma-associated symptoms such as primary aldestronism (PA) indicates that adenoma cells are relatively larger with different cytoplasm, and increased variation in nuclear size. This indication is based on comparison between the healthy (normal) and affected (adenoma-associated) adrenal cortex tissue samples. Adrenocortical adenomas are most commonly distinguished from adrenocortical carcinomas (their malignant counterparts) by the Weiss system, as follows:
Total score indicates:
0-2: Adrenocortical adenoma
3: Undetermined
4-9: Adrenocortical carcinoma

Treatment
Non-functioning cases of adrenocortical adenoma can be managed through long-term followups and monitoring. The treatment approach for the functioning cases of adrenocortical adenoma depends on the type of disorders they induce and their advancement.
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