Objective: The optimal management and follow-up strategies for adrenal incidentalomas (AIs) remain controversial, with conflicting guidelines on routine imaging versus surveillance. This study investigates the prognostic utility of the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, previously validated in malignancies, as a potential predictor of AI growth over a one-year period. Methods: This retrospective study included 66 female patients (aged 18–80 years) with incidentally detected adrenal masses, who underwent at least two imaging scans within a one-year period. The HALP score at diagnosis and the change in adrenal mass diameter between baseline and follow-up imaging were assessed. Growth of adrenal mass was defined as an increase in diameter ≥3 mm. Results: Patients with growing AIs exhibited lower baseline HALP scores compared to those with stable lesions (p = 0.093). A significant negative correlation was observed between HALP score and diameter change in a subgroup of patients with growth ≥3 mm (Spearman’s rho = -0.766, p = 0.010). However, HALP score was not a significant predictor of AI growth according to logistic regression analysis (p > 0.05). Conclusion: Although an inverse association exists between the HALP score and AI growth, it lacks sufficient predictive accuracy to serve as a standalone marker for short-term prognosis. Larger-scale, long-term studies are needed to explore its potential role in AI management.