Question: Do you have any statistics on incidentalomas?  I’ve heard that as many as one in five people have one, and I often wonder if some patients with several of the typical Cushing’s symptoms get scanned and find a tumor on the pituitary or adrenal – how could they determine conclusively that the tumor is non-active / non-secreting when it presents on an MRI and they have physical symptoms of Cushing’s?

Answer: Pituitary incidentalomas are found in approximately 15% of the general population upon undergoing MRI imaging. Most of these lesions are small cysts or adenomas and do not associate a high cortisol problem. However, once a pituitary incidentaloma is detected, the patient must undergo a clinical and laboratory evaluation by an endocrinologist. If patient has manifestations of high cortisol, appropriate testing will be ordered. In addition, imaging surveillance of the pituitary lesion is necessary.

Adrenal incidentalomas are detected with increasing frequency over our life span (up to 30%). They can be nonfunctioning adenomas, adenomas that secrete cortisol, cysts, pheochromocytomas, primary adrenal cancers, metastases and other. Similar with pituitary incidentalomas, patients benefit from endocrinological evaluation that will include specific cortisol testing.

By Dr. Adriana Ioachimescu, Emory University Hospital, Atlanta, GA  (Winter-Spring 2018)