Table 4.

Elements of a focused history and physical examination are tailored towards detecting possible etiologies for an adrenal incidentaloma

Condition	History	Physical exam
Hypercortisolism (Cushing’s s yndrome)	Weight gain, central obesity, easy bruising, severe hypertension, diabetes, proximal muscle weakness, fatigue, depression, sleep disturbances, menstrual irregularities and virilization (in females), or fragility fractures	Hypertension, central obesity, supraclavicular fat accumulation, a dorsocervical fat pad, facial plethora, thinned skin, purple and wide (>1 cm) striae, acne, ecchymoses, hirsutism, and proximal muscle weakness or wasting
Aldosteronism	Hypertension, hypokalemia, muscle cramping and weakness, headaches, intermittent or periodic paralysis	Hypertension, fluid retention
Pheochromocytoma	Headaches, anxiety attacks, sweating, palpitations, or family history of von Hippel-Lindau disease, multiple endocrine neoplasia type 2, familial paraganglioma syndrome, or neurofibromatosis type 1	Severe hypertension, tachycardia, arrhythmias, congestive heart failure, excessive sweating, anxiety, and pallor
Adrenocortical c arcinoma	Flank pain, vague abdominal discomfort, hypercortisolism, virilization, feminization or aldosteronism	Weight loss, hirsutism, gynecomastia, signs of hypercortisolism
Metastasis	Personal and family history of malignant lesions, weight loss, unexplained fevers, lack of adherence to an age-appropriate cancer screening program, and smoking history	Lymphadenopathy, lung mass, breast mass, renal mass or skin lesion suspicious for melanoma, as well as other cancer-specific findings