Objective  To investigate the clinical characteristics of adrenal incidentaloma and explore the management strategies for this disease.

  Methods  The clinical data of adrenal neoplasm patients admitted in The First Affiliated Hospital and Cancer Center of Sun Yat-sen University from January 2001 to January 2013 were analyzed retrospectively.

  Results  The data of 667 patients with adrenal incidentaloma were analyzed. Adenoma was the most common tumor in 511 cases with pathological results (240/511, 47%). Furthermore, the pathologic results indicated that 18% (90/511) of these cases were pheochromocytoma and 8% (41/511) were adrenocortical carcinoma. Of the 511 cases, 266 had ≤4 cm tumors, and 245 had >6 cm tumors. In cases with ≤4 cm tumors, 260 (98%) had benign tumors, and 183 of these cases underwent laparoscopic adrenalectomy. In cases with >6 cm tumor, 91 cases (37%) had malignant tumors, and 162 of these cases underwent open adrenalectomy.

  Conclusion  The suggested cut-off size for adrenal incidentaloma diagnosis is 4 cm. Laparoscopic adrenalectomy is the recommended management strategy for small (≤4 cm) and nonfunctional adrenal incidentaloma.