Partial adrenalectomy for nonfunctioning incidentaloma has been performed by some authors (26). The main indication for surgical treatment of incidentaloma is the suspicion of malignancy. This is assessed based on tumor size greater than 5 cm, functional status (nonfunctioning), and high signal intensity on T2-weighted magnetic resonance imaging images. Watchful waiting is well accepted for lesions smaller than 3 cm. Lesions between 3 and 5 cm represent the main area of controversy. However, despite the majority of these lesions ultimately proving to be benign on final pathology, malignancy can occur occasionally (27). Hence, unilateral total adrenalectomy still remains the gold standard treatment for patients with a normal contralateral adrenal gland, with no predisposition for multiple tumors, and with suspected malignant lesions.

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