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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| | {{Incidentaloma}} |
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| {{SI}} | | {{CMG}}; {{AE}} {{Mohamed riad}} {{MAD}} |
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| | '''For patient information, click [[Incidentaloma (patient information)|here]]''' |
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| == Overview ==
| | {{SK}} Adrenal incidentaloma |
| An '''incidentaloma''' is a [[tumor]] (''-oma'') found by coincidence (''incidental'') without clinical [[symptom]]s and 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 [[radiology|diagnostic imaging]] is used for the analysis of unrelated symptoms. With the increase of "whole-body [[CT scan]]ning" 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.<ref name="pmid16170016">{{cite journal |author=Furtado CD, Aguirre DA, Sirlin CB, ''et al'' |title=Whole-body CT screening: spectrum of findings and recommendations in 1192 patients |journal=Radiology |volume=237 |issue=2 |pages=385-94 |year=2005 |pmid=16170016 |doi=10.1148/radiol.2372041741}}</ref>
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| 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.
| | ==[[Incidentaloma overview|Overview]]== |
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| == Adrenal incidentaloma == | | ==[[Incidentaloma historical perspective|Historical Perspective]]== |
| In adrenal gland tumors, a dexamethasone suppression test is often used to detect [[cortisol]] excess, and [[metanephrine]]s or [[catecholamine]]s 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]].<ref name="pmid12614096">{{cite journal |author=Grumbach MM, Biller BM, Braunstein GD, ''et al'' |title=Management of the clinically inapparent adrenal mass ("incidentaloma") |journal=Ann. Intern. Med. |volume=138 |issue=5 |pages=424-9 |year=2003 |pmid=12614096 |doi=}}</ref>
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| Hormonal evaluation includes<ref name="pmid17287480">{{cite journal |author=Young WF |title=Clinical practice. The incidentally discovered adrenal mass |journal=N. Engl. J. Med. |volume=356 |issue=6 |pages=601-10 |year=2007 |pmid=17287480 |doi=10.1056/NEJMcp065470}}</ref>:
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| * 1-mg overnight dexamethasone suppression test
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| * 24-hour urinary specimen for measurement of fractionated metanephrines and catecholamines
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| * plasma aldosterone concentration and plasma renin activity ''if hypertension is present''
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| 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<ref name="pmid17287480"/>
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| == Renal incidentaloma == | | ==[[Incidentaloma classification|Classification]]== |
| Most renal cell cancers are now found incidentally.<ref name="pmid11343669">{{cite journal |author=Reddan DN, Raj GV, Polascik TJ |title=Management of small renal tumors: an overview |journal=Am. J. Med. |volume=110 |issue=7 |pages=558-62 |year=2001 |pmid=11343669 |doi=10.1016/S0002-9343(01)00650-7 }}</ref> Tumors less than 3 cm in diameter less frequently have aggressive histology.<ref name="pmid16890647">{{cite journal |author=Remzi M, Ozsoy M, Klingler HC, ''et al'' |title=Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter |journal=J. Urol. |volume=176 |issue=3 |pages=896-9 |year=2006 |pmid=16890647 |doi=10.1016/j.juro.2006.04.047}}</ref>
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| == Pituitary incidentaloma == | | ==[[Incidentaloma pathophysiology|Pathophysiology]]== |
| 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.<ref name="pmid8154641">{{cite journal |author=Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH |title=Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population |journal=Ann. Intern. Med. |volume=120 |issue=10 |pages=817-20 |year=1994 |pmid=8154641 |doi=}}</ref> When encountering such a lesion, long term surveillance has been recommended.<ref name="pmid9429857">{{cite journal |author=Molitch ME |title=Pituitary incidentalomas |journal=Endocrinol. Metab. Clin. North Am. |volume=26 |issue=4 |pages=725-40 |year=1997 |pmid=9429857 |doi=}}</ref> 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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| == Thyroid incidentaloma == | | ==[[Incidentaloma causes|Causes]]== |
| Incidental [[thyroid]] masses may be found in 9% of patients undergoing bilateral carotid duplex ultrasonography. <ref name="pmid16230549">{{cite journal |author=Steele SR, Martin MJ, Mullenix PS, Azarow KS, Andersen CA |title=The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography |journal=Archives of surgery (Chicago, Ill. : 1960) |volume=140 |issue=10 |pages=981-5 |year=2005 |pmid=16230549 |doi=10.1001/archsurg.140.10.981}}</ref>
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| Some experts<ref name="pmid15941700">{{cite journal |author=Castro MR, Gharib H |title=Continuing controversies in the management of thyroid nodules |journal=Ann. Intern. Med. |volume=142 |issue=11 |pages=926-31 |year=2005 |pmid=15941700 |doi=}}</ref> recommend that nodules > 1 cm (unless the [[Thyroid-stimulating hormone|TSH]] is suppressed) or those with ultrasonographic features of malignancy should be biopsied by fine needle aspiration. Computed tomography is inferior to ultrasound for evaluating thyroid nodules.<ref name="pmid17056928">{{cite journal |author=Shetty SK, Maher MM, Hahn PF, Halpern EF, Aquino SL |title=Significance of incidental thyroid lesions detected on CT: correlation among CT, sonography, and pathology |journal=AJR. American journal of roentgenology |volume=187 |issue=5 |pages=1349-56 |year=2006 |pmid=17056928 |doi=10.2214/AJR.05.0468}}</ref> Ultrasonographic markers of malignancy are<ref name="pmid11994321">{{cite journal |author=Papini E, Guglielmi R, Bianchini A, ''et al'' |title=Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=5 |pages=1941-6 |year=2002 |pmid=11994321 |doi=}}</ref>:
| | ==[[Incidentaloma differential diagnosis|Differentiating Incidentaloma from other Diseases]]== |
| * solid hypoechoic appearance
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| * irregular or blurred margins
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| * intranodular vascular pattern
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| * microcalcifications
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| * Irregular margins
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| * intranodular vascular spots
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| * microcalcifications
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| == Parathyroid incidentaloma == | | ==[[Incidentaloma epidemiology and demographics|Epidemiology and Demographics]]== |
| Incidental [[parathyroid]] masses may be found in 0.1% of patients undergoing bilateral carotid duplex ultrasonography. <ref name="pmid16230549">{{cite journal |author=Steele SR, Martin MJ, Mullenix PS, Azarow KS, Andersen CA |title=The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography |journal=Archives of surgery (Chicago, Ill. : 1960) |volume=140 |issue=10 |pages=981-5 |year=2005 |pmid=16230549 |doi=10.1001/archsurg.140.10.981}}</ref>
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| == Others == | | ==[[Incidentaloma risk factors|Risk Factors]]== |
| Other organs that can harbor incidentalomas include the [[liver]] (often a [[hemangioma]]).
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| == Scientific criticism == | | ==[[Incidentaloma screening|Screening]]== |
| The concept of the incidentaloma has been criticized, as such lesions do not have much in common other than the history of an incidental identification and the assumption that they are clinically inert. It has been proposed just to say that such lesions have been "incidentally found."<ref name="pmid12455801">{{cite journal |author=Mirilas P, Skandalakis JE |title=Benign anatomical mistakes: incidentaloma |journal=The American surgeon |volume=68 |issue=11 |pages=1026-8 |year=2002 |pmid=12455801 |doi=}}</ref> The underlying pathology shows no unifying histological concept.
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| ==Sources== | | ==[[Incidentaloma natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| www.wikipedia.org
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| ==References== | | ==Diagnosis== |
| {{Reflist|2}}
| | [[Incidentaloma history and symptoms|History and Symptoms]] | [[Incidentaloma physical examination|Physical Examination]] | [[Incidentaloma electrocardiogram|Electrocardiogram]] | [[Incidentaloma laboratory findings|Laboratory Findings]] | [[Incidentaloma x ray|X-Ray Findings]] | [[Incidentaloma echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Incidentaloma CT scan|CT-Scan Findings]] | [[Incidentaloma MRI|MRI Findings]] | [[Incidentaloma other diagnostic studies|Other Diagnostic Studies]] | [[Incidentaloma other imaging findings|Other Imaging Findings]] |
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| [[Category:Disease]] | | ==Treatment== |
| [[Category:Radiology]] | | [[Incidentaloma medical therapy|Medical Therapy]] | [[Incidentaloma surgery|Surgery]] | [[Incidentaloma primary prevention|Primary Prevention]] | [[Incidentaloma secondary prevention|Secondary Prevention]] | [[Incidentaloma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Incidentaloma future or investigational therapies|Future or Investigational Therapies]] |
| [[Category:Endocrinology]] | | |
| [[Category:Oncology]] | | ==Case Studies== |
| [[Category:Mature chapter]] | | [[Incidentaloma case study one|Case #1]] |