What is the recommended workup for adrenal incidentalomas?

All adrenal incidentalomas require hormonal evaluation: 1mg dexamethasone suppression test for cortisol excess, plasma metanephrines for pheochromocytoma, and aldosterone/renin ratio if hypertensive. CT imaging characteristics guide malignancy risk assessment. Lesions <4cm with benign features and no hormone excess can be monitored. Surgery is indicated for functional tumors or high malignancy suspicion.