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In medicine, an incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms or suspicion. It is a common problem: up to 7% of all patients over 60 may harbor a benign growth, often of the adrenal gland, which is detected when diagnostic imaging is used for the analysis of unrelated symptoms. With the increase of “whole-body CT scanning” as part of health screening programs, the chance of finding incidentalomas is expected to increase. 37% of patients receiving whole-body CT scan may have abnormal findings that need further evaluation.[1]
When faced with an unexpected finding on diagnostic imaging, the clinician faces the challenge to prove that the lesion is indeed harmless. Often, some other tests are required to determine the exact nature of an incidentaloma.
In adrenal gland tumors, a dexamethasone suppression test is often used to detect cortisol excess, and metanephrines or catecholamines for excess of these hormones. Tumors under 3 cm are generally considered benign and are only treated if there are grounds for a diagnosis of Cushing’s syndrome or pheochromocytoma.[2] Hormonal evaluation includes[3]:
On CT scan, benign adenomas typically are low radiographic density (due to fat content) and rapid washout of contrast medium (50% or more of the contrast medium washes out at 10 minutes). If the hormonal evaluation is negative and imaging suggests benign, followup should be considered with imaging at 6, 12, and 24 months and repeat hormonal evaluation yearly for 4 years[3]
Most renal cell cancers are now found incidentally.[4] Tumors less than 3 cm in diameter less frequently have aggressive histology.[5]
Autopsy series have suggested that pituitary incidentalomas may be quite common. It has been estimated that perhaps 10% of the adult population may harbor such endocrinologically inert lesions.[6] When encountering such a lesion, long term surveillance has been recommended.[7] Also baseline pituitary hormonal function needs to be checked, including measurements of serum levels of TSH, prolactin, IGF-I (as a test of growth hormone activity), adrenal function (i.e. 24 hours urine corticol,dexamethasone suppression test). teststerone in men and estradial in amenorrheic women.
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