The prevalence of adrenal incidentaloma has increased with the increasing use of imaging techniques. While majority are benign adenoma, a small but significant minority may be primary adrenal carcinoma or have endocrine hyper secretion. Existing guidance suggests that excess catecholamine and cortisol secretion should be ruled out in all cases and excess aldosterone secretion should be ruled out in hypertensive patients. Repeat evaluation after a period of time is also suggested. We have reviewed the management of adrenal incidentaloma in a large district general hospital in the North West of England.