Endocrine Abstracts

Objectives

To compare our practice, at Sunderland Royal Hospital, to the recommendations of NIH Consensus Development Programme (February 2002) and BAES.

Method

Retrospective audit of patients who had adrenal mass on imaging studies done between 1996–2004.

Patients who had incidentally detected adrenal mass were included. Patients with symptoms and / or signs suggesting adrenal mass prior to imaging and patients with adrenal tumours observed during staging imaging for non-adrenal malignancies were excluded.

Audit standards

All patients with an incidentaloma should have-1 mg Overnight Dexamethasone Stress Test; 24 hour urinary catecholamine (UFC) and/or plasma metanephrine assessment; should have estimation of serum potassium & plasma aldosterone/ plasma renin activity ratio if hypertensive; surgical removal if functioning or non-functioning with size >3 cm; non-functioning adenomas <3 cm should have 2 imaging studies at least 6 months apart before discharge.

Results

Ten out of total 24 adrenal masses detected during study period were true incidentalomas. The prevalence in SRH during the study period:1/1000 scans/year(approx). General data showed the mean age to be 63 years, equal sex ratio, 70% of the incidentalomas being >3 cm and 60% had unilateral mass. Further analysis showed that 30% were mets, 50% non-functioning adenomas, 10%pheochromo-cytomas and 10% were undiagnosed. Only 10% and 40% of the patients had ODST and 24 hours UFC done respectively. No true incidentaloma patients had hypertension. One patient who had functional mass had surgery appropriately but only 43% of patients with larger (>3 cm) mass had surgery. Follow ups were carried out appropriately in 66% of patients.

Conclusion

Failure to achieve the audit standards could be due to the fact that there was no standardised recommendation available at that time.

Recommendation

Re-audit in few years time after making all relevant departments aware of the recommendations of NIH and BAES.