An incidentaloma is an unexpected mass, lesion, or tumour found on a medical imaging that was performed for an entirely unrelated reason. It is a creation of technology. Management of pituitary incidentalomas is guided by identity, prevalence, relevance, natural history and attendant risk profile. Adenomas are the commonest findings among incidental pituitary lesions. Occult adenomas occur in about 10% of the general population however only 0.1% of these cause morbidity, amounting to 100 per million population, of which about 2/3 are picked up early with hyperfunctioning disease. Among those with non-functioning lesions, a systematic review reported that among microadenomas 3 per 100 person-years, and among macroadenomas 12 per 100 person years grew. However there was great variability including shrinkage. The risk profile of functioning and non-functioning incidentalomas is influenced by size, secretory function, location, symptoms, invasion, histology, family history and whether it is syndromic. A clinical classification based on the grading of risk profile combining clinical, radiological and genetic information can be applied to guide the management of pituitary incidentalomas.