Deciphering adrenal cysts: unveiling insights into imaging, histology, and optimal management approaches

Adrenal cysts are rare lesions that are increasingly discovered incidentally during radiological examinations conducted without suspicion of adrenal disease. Typically benign, hormonally nonfunctional, and asymptomatic, these lesions may occasionally manifest mass effect symptoms such as pain or abdominal discomfort, particularly in large cysts. Management approaches vary from no follow-up to hormonal investigation, imaging follow-up, or adrenalectomy, especially if the cyst is growing or exhibits an atypical appearance. Due to the rarity of adrenal cysts, all new cases should ideally be discussed at an adrenal multidisciplinary team meeting. In this comprehensive review, we illustrate the clinical, radiological and histological features of adrenal cysts by showcasing four typical patient cases, and also summarize the most important take-home messages for optimal clinical management.