Endocrine Abstracts

Introduction: Adrenal masses may be found as incidental features during abdominal imaging investigations, raising questions as to the need to investigate these lesions for endocrine function or malignancy. This audit utilised published articles and consensus papers to compare our current approach with reported practice in other centres.

Method: A retrospective review of the case notes of 21 patients referred to the Endocrine service in the Trust from November 2005 to January 2008. Data was collected from clinic letters and investigations. Standards included measurement of biochemical parameters (potassium, renin/aldosterone ratio, 24 h urinary catecholamines/metanephrines/cortisol, and dexamethasone suppression tests) assessment of radiological features and whether interval scanning took place.

Results: The average patient age was 64.7 years and 66% of casenotes commented on clinical features of endocrinopathy. Biochemical measurements were performed as follows: urinary catecholamines and/or metanephrines in 81%, urinary cortisol in 62%, renin/aldosterone ratio in 43%, and overnight dexamethasone suppression test in 38%. Hundred percent of patients had potassium measured.

Imaging revealed the average lesion size to be 2.7 cm, with one lesion >10 cm. One patient had bilateral masses. Of 19% of cases had documented Hounsfield units of the mass. Contrast washout was documented in 0% of cases.

Seventy one percent of cases had follow up interval scanning (12/17). Of the other 4 cases, one declined follow up, two died and one phaeochromocytoma was identified. One patient had both increased cortisol with increased ACTH and remains under investigation.

Conclusion: This series revealed a diagnostic rate of 5–10% for endocrine pathology. There is room to improve the comprehensive investigation of such cases in our practice and the introduction of local guidelines may be of benefit.