Endocrine Abstracts

An adrenal incidentaloma is defined as an adrenal mass >1 cm diameter, discovered serendipitously on radiological imaging done for another reason. They are important because a percentage will turn out to be malignant or secrete excess hormones. The aim of the current study was to ascertain if these lesions were being investigated and followed appropriately compared to American Association of Clinical Endocrinologists guidelines. All imaging reports for the calendar year 2010 were searched for the terms ‘adrenal’ and ‘adenoma’ and then checked manually. Imaging done for staging of cancer or for investigation of possible adrenal disease was excluded. 95 patients were identified. Clinical information was obtained form the Northern Ireland Electronic Care Record and clinical notes. Incidentalomas were commoner in older patients, 49 of the patients were over 70 years of age. 64 patients had no follow up imaging performed, including two patients with lesions greater than 4 cm in diameter. Three patients were under the care of endocrinology or endocrine surgery. 19 patients were referred to endocrinology. 25 patients were screened for hypercortisolaemia, 25 were screened for phaeochromocytoma, 70 patients underwent no screening for hormonal excess. 35 patients had a history of hypertension but only nine were screened for primary hyperaldosteronism. All patients referred to endocrinology or endocrine surgery were investigated according to guidelines. Only three patients not referred to endocrinology underwent appropriate investigations with screening for hypercortisolaemia or phaeochromocytoma. In summary, the majority of adrenal incidentalomas are not followed up appropriately. To address this radiology will, in future, advise endocrine referral for patients with incidentally detected adrenal lesions >1 cm in diameter.