[Comment] More liberal use of bilateral adrenalectomy for bilateral adrenal tumours with cortisol excess

Bilateral adrenal tumours with cortisol hypersecretion represent a common clinical challenge. Adrenal incidentalomas are detected in approximately 4% of abdominal imaging studies, with prevalence increasing with patient age. Approximately 20% of adrenal incidentalomas are bilateral.1 Hormone excess is common in bilateral adrenal lesions, most often due to mild autonomous cortisol secretion (MACS), which accounts for approximately one-fifth of cases. In contrast to unilateral adrenal tumours, for which adrenalectomy is the standard treatment for overt Cushing's syndrome, the management of bilateral adrenal tumours with hypercortisolism (whether Cushing's syndrome or MACS) is more nuanced, requiring a dynamic, personalised approach.