Incidentalomas - A disease of modern technology

This article addresses the problems of preclinical or subclinical ''disease'' of the adrenal and pituitary glands related to the extensive use of sophisticated diagnostic tools. The diagnostic and management problems faced by endocrinologists in distinguishing most benign pituitary and adrenal incidentalomas from other adrenal and pituitary masses, either malignant or hormone secreting, that require further therapy are reviewed. An evidence-based approach is developed that is guided by the answers to the following questions: (1) does an incidental mass put the patient at increased risk for an adverse outcome? (2) can individuals with treatable syndromes be accurately diagnosed? (3) is the treatment of these syndromes more effective in presymptomatic patients? and (4) do the beneficial effects of presymptomatic detection and treatment of these patients justify the costs incurred? This framework is used to discuss incidentalomas with recognition of the controversies that surround their management.