Endocrine Abstracts

Adrenal incidentaloma is a clinically silent adrenal mass detected on imaging performed for unrelated reasons. The concern is whether the incidentaloma is malignant or hypersecreting. The most comprehensive existing guidelines on investigation and management come from NIH Consensus Development Programme.

We aimed to determine how many are identified by radiology over 12 months; how many of these are referred to endocrinology; how many are appropriately investigated using NIH guidelines.

We searched Clinical Radiology Information System reports between 01/11/2007 and 01/11/2008 for the terms adrenal adenoma, nodule, incidentaloma, mass and tumour. Exclusions: patients with current malignancy/still under surveillance; patients having suspected adrenal pathology; cysts; haemorrhage; angiomyolipoma; tuberculosis; deceased. Of those with adrenal incidentaloma, we established if referral had taken place to ourselves and searched the results server for evidence of investigation by clinicians other than us.

We found 394 reports for 305 patients. Exclusions: ‘no adrenal masses’ (88), deceased patients (8) patients with active malignancy/under 5 year surveillance (102), specific adrenal imaging (12), incidentalomas found prior to 01/11/2007 (15), angiomyelolipoma (2), haemorrhage (1), cysts (2), mycobacterial disease (2), extra-adrenal mass on further imaging (2), patients with uncertain eligibility (2). This left 69 patients with adrenal incidentaloma. Fifty were <4 cm; 4 were 4–6 cm; 1 was >6 cm and 14 had no size reported. One patient was referred to us; 2 patients were referred for endocrine conditions other than adrenal lesions. Three patients had assessment for catecholamine excess; 1 had aldosterone/renin levels. Fourteen patients had follow-up imaging with no significant growth.

We conclude that patients with adrenal incidentaloma are not routinely referred to endocrinology services and underlying adrenal hypersecretion is likely to be missed in a significant minority of cases. We are currently addressing this issue locally but acknowledge this will have some resource implications.