In the systematic review and meta-analysis of more than 4,000 patients with adenomas published in the Annals of Internal Medicine (Elhassan et al), authors reported that patients with mild autonomous cortisol secretion or nonfunctioning adrenal adenomas very rarely develop overt hormonal excess (<0.1%). In addition, adenoma growth >1cm occurred only in 2.5% of patients and no patient developed an adrenal malignancy at follow up.