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Adrenal incidentaloma

In medicine, an incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms 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 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. more...

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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.

Adrenal 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 (Grumbach et al 2003).

Pituitary incidentaloma

Autospy 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 (Hall et al). When encountering such a lesion, long term surveillance has been recommended (Molitch). Also baseline pituitary hormonal function needs to be checked, inculding measurements of serum levels of TSH, prolactin, IGF-I (as a test of growth hormone activity), and adrenal function (i.e. dexamethasone suppression test).

Others

Other organs that can harbor incidentalomas are the liver (often a hemangioma), thyroid, parathyroid, and the kidneys.

Scientific criticism

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." (Miralas et al) The underlying pathology shows no unifying histological concept.

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Partnership to Broaden Research Used In Consensus Conferences - Agency for Healthcare Research and Quality and the Office of Applications of Research form
From American Family Physician, 2/1/02 by Rosemarie Sweeney

The AHRQ and the Office of Applications of Research (OMAR) at the National Institutes of Health (NIH) have formed a partnership to ensure that the panelists of NIH Consensus Development Conferences have the most up-to-date scientific evidence to support their proceedings. AHRQ will provide evidence-based reports on selected topics developed by its Evidence-based Practice Centers (EPCs) for Consensus Development Conferences in 2002 and 2003. The EPCs review all available, relevant scientific literature on clinical topics, produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities. OMAR works with the NIH institutes, centers, and offices to assess, translate, and disseminate the results of biomedical research that can be used in the delivery of health services. The first four topics and dates of the conferences are: Endoscopic Retrograde Cholangiopancreatography (ERCP) for Diagnosis and Therapy, January 14-16, 2002; Management of the Clinically Inapparent Adrenal Mass (Incidentaloma), February 4-6, 2002; Management of Hepatitis C, June 10-12, 2002; Symptom Management in Cancer: Pain, Depression and Fatigue, July 15-17, 2002. A summary of each AHRQ Evidence Report developed for an OMAR conference will be available on the AHRQ Web site at www.ahrq.gov/clinic/epcix.htm.

COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group

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