Interpreting incidental adrenal adenoma on CT – next steps?

A density of 15 HU is above the 10 HU threshold for lipid-rich adenoma. You'd want a dedicated adrenal protocol CT with washout values. If absolute washout >60% or relative >40%, adenoma is confirmed. Also check bloods: metanephrines, aldosterone/renin ratio, cortisol suppression test.

The endocrine workup is mandatory regardless of imaging — you need to rule out pheo before any intervention or anesthesia. Size <4cm with benign imaging features and negative biochemistry = follow-up imaging at 6–12 months.