A critical step in the operative management of non-functioning asymptomatic incidentaloma.

Incidentalomas are more frequently diagnosed now due to easy availability of radiological diagnostic techniques. These tumors pose a new challenge for development of therapeutic and preoperative evaluation strategies. The natural course of adrenal incidentalomas and the risk that such lesions lead to hormonal hypersecretion and malignancy are still under evaluation. Factors influencing transformation of a truly non-functioning incidentaloma into a hypersecretory or a malignant tumor are not entirely known. Surgery is recommended on the basis of functional type of the tumor and the potential for malignancy. Tumor size is being recommended to be the most reliable criterion for malignant potential. Surgery for adrenal tumors is fraught with perioperative complications unless the patient has been preoperatively prepared. The worst case scenario is seen in cases of pheochromocytoma, which are not preoperatively prepared as this case demonstrates. There are no clear recommendations in contemporary literature as to the pre-operative preparation of non-secretory, asymptomatic incidentaloma in normotensive individuals with normal biochemical and endocrinological profile.