Incidentaloma

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Classification according to ICD-10
R90 - R93 Abnormal findings with no diagnosis on diagnostic imaging
ICD-10 online (WHO version 2019)

Incidentaloma (also Inzidentom , engl. Incidentaloma ) is a derived Neologismus for the Anglo-Saxon incidental tumor . This describes a mass (a tumor) that is found by chance , usually during radiological examinations or other imaging procedures, without any clinical symptoms or initial suspicion. Doctors speak of incidental findings .

A common problem is that seven percent of all patients over 60 years of age have benign growth, often of the adrenal gland , which is detected during image diagnostics to examine other symptoms. With the increase in whole-body CT analyzes for health care (USA), faster early detection is expected.

With the unexpected discovery on diagnostic images, the doctor is faced with the question of whether the changes are actually harmless. Therefore further tests are usually necessary.

Incidentalomas of the adrenal gland

In the case of adrenal tumors, a dexamethasone suppression test is often performed in order to detect excess cortisol in the context of Cushing's syndrome . Further endocrinological examinations include laboratory diagnostics with detection of metanephrine and normetanephrine to exclude a pheochromocytoma and the determination of the renin-aldosterone quotient to exclude primary hyperaldosteronism . Tumors less than three centimeters in size are generally considered to be benign and are only treated if Cushing's syndrome, primary hyperaldosteronism, or pheochromocytoma are diagnosed .

Pituitary incidentaloma

Routine examinations showed that pituitary tumors are relatively common. It is believed that around ten percent of adults have such endocrinological lesions (Hall et alii ). The further procedure depends on the tumor size (microadenoma / macroadenoma). After testing the hormone activity (especially of prolactin) or the pituitary function, the indication for the operation is clarified in a specialized center.

Further

Other organs may also be affected by incidentalomas, such as the liver (often a hemangioma ), thyroid , parathyroid, and kidneys .

Scientific criticism

The concept of incidentalomas has been criticized because apart from the incidental finding and the fact that they are clinically inactive, such lesions do not have much in common. The pathology does not show a uniform histological pattern.

Individual evidence

  1. ↑ Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 16
  2. ↑ MM Grumbach, BM Biller, GD Braunstein, KK Campbell, JA Carney, PA Godley, EL Harris, JK Lee, YC Oertel, MC Posner, JA Schlechte, HS Wieand: Management of the clinically inapparent adrenal mass ("incidentaloma"). In: Ann Intern Med . 2003; 138, pp. 424-429. PMID 12614096 .

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