Endocrine Abstracts

Adrenal incidentalomas are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in a number of investigations usually conducted in the Endocrinology clinic.

In 2011 we audited the prevalence and management of adrenal incidentalomas identified on abdominal CT imaging over one calendar month in our centre. Consequently, a decision pathway for new adrenal lesions was introduced in the Radiology department. This pathway is based on lesion imaging characteristics and a brief clinical assessment. A year later we re-audited the local practice.

690 CT scans were reviewed in 2011 and 1264 in 2012. In 2011, 32/690 (4.64%) scans with adrenal lesions were identified and in 2012, 85/1264 (6.7%). In both the 2011 and the 2012 cohorts, the majority of patients with adrenal lesions found on imaging, had a known malignancy or adrenal metastasis and were under Oncological care (13/32, 40.6% in 2011; 42/85, 49.4% in 2012). Excluding patients with malignancy and other radiological diagnosis, 17 (2.46%) patients in 2011 and 26 (2.01%) in 2012 with adrenal incidentalomas were identified. Of those, 1.01% in 2011 and 0.95% in 2012 had newly identified incidentalomas. Only a minority of patients with incidentalomas had testing to exclude a functional lesion (5/17, 29.4% in 2011; 4/26, 15.4% in 2012). Hounsfield units were reported in 9/17, 52.9% in 2011 and in 8/26, 30.8% patients with incidentalomas in 2012. There was inconsistent terminology in reporting adrenal lesions.

We support comprehensive reporting of incidentalomas and a selective testing strategy.