It varies depending on the underlying disease. There is no race predilection. There is no sex predilection. There may be evidence of systemic disease such as carcinoma, amyloidosis, or granulomatous disease. Often, no clinical clues can be found and other information is needed for diagnosis.
Larger tumors are more likely to be malignant.
The cutoff criterion for suspicion of malignancy ranges between 3-6 cm in diameter. The best hope for a surgical cure is a lower cutoff, but this means a greater number of benign tumors will be unnecessarily removed. The cellular mechanisms for primary adrenocortical tumorigenesis are just beginning to be understood. Tumor markers also are present in other syndromes. Most frequently, cortisol produces subclinical Cushing's syndrome.