Endocrine Abstracts

An incidentaloma is a mass lesion found by chance on imaging for a reason unrelated to the site of the lesion. Adrenal incidentalomas, as a result of advances in imaging technology, have an increased incidence, especially in the aging population. An endocrine referral is advised to determine if the lesion is functional, to exclude malignancy and offer on going appropriate follow-up.

Aim: To assess the incidence and audit the management of adrenal incidentalomas at a district general hospital.

Method: Abdominal and pelvis CT scan reports between 04/02/2012 and 04/02/2013 were retrospectively reviewed for a comment on adrenal glands. If abnormal, clinical records were reviewed. If not commented on, the scans were reviewed by a consultant radiologist, and clinical records reviewed if the adrenals were abnormal.

Results: 2701 images were pooled. 51% (1380) had a comment on adrenals. 45 images had abnormal adrenals of which 32 (2, 4%) were incidentalomas. These incidentalomas were predominantly left sided (20), and four were bilateral. The reported diameters ranged from 9 to 60 mm.

Only three patients had endocrine referrals. Six patients died within 8 weeks of the CT scan due to other co morbidities.49% (1321) of the image reports had no comment regarding the adrenals. Currently 52 of the 1321 scans have been randomly selected and formally reviewed by a radiologist. Five of the 52 had abnormal adrenals, three ‘bulky left adrenal glands’, and two left sided adenomas, 10 and 15 mm in diameter.

Discussion: Clinicians still need enhanced awareness of the importance to refer patients with adrenal incidentalomas for endocrine evaluation and follow-up. CT scan reporting needs to include a comment on the adrenal glands if imaged, and also prompting clinicians to refer patients with adrenal incidentalomas to the local endocrinologists.