SFEBES2018 Poster Presentations Adrenal and steroids (38 abstracts)
Addressing adrenal incidentalomas (AIs): a snapshot of the investigation of AIs in a tertiary endocrine centre and the effect of implementing a local management pathway
Anna Scholz 1 , Mohammed Rahman 2 , Janet Lewis 1 , Eleanor Gait-Carr 1 , Gala Gutiérrez Buey 3 , Carolyn Tang 1 , Jennifer Brooke 4 , Ruth Ellis-Owen 1 , Aled Rees 1 & Andrew Lansdown 1
1University Hospital of Wales, Cardiff, UK; 2Wrexham Maelor Hospital, Wrexham, UK; 3Hospital Valle del Nalon, Asturias, Spain; 4Cardiff University, Cardiff, UK.
Introduction: Adrenal incidentalomas (AIs) are found in ~3% abdominal scans, rising to 10% in the elderly. In 2016, the European Society of Endocrinology (ESE) published new guidance on their management.
Aims & objectives: To (1) compare how AIs have been managed at the University Hospital of Wales (UHW) against ESE guidelines, and (2) provide an early evaluation of the impact of service changes implemented based on initial findings.
Methods: Reports of radiological scans performed at UHW (2011–2013) including terms related to an adrenal mass/lesion were retrieved. Electronic patient records were accessed to determine the characteristics reported in the initial radiological scan, the type of hormonal investigations requested and if any follow-up investigations were undertaken.
Results: Four hundred and sixty five patients with adrenal masses were identified. 79 (17%) were investigated by Endocrinology. Radiological characterisation: Lesion size was recorded in 96%, character in 63% and Hounsfield Units (HU) in only 9%. Hormonal evaluation: Metanephrines were measured in 94%, 86% had an overnight dexamethasone suppression test and 82% at least one urinary free cortisol. Patient records of 100 consecutive search results were also analysed to investigate the low referral rate: a total of 35 met the criteria for further investigation, but only 12 were referred to Endocrinology.
Conclusions: (1) Only a small fraction of AIs were referred to Endocrinology for further assessment; (2) There is significant variation in radiological reporting; (3) Whilst most patients undergo appropriate initial hormonal evaluation, many tests were unnecessary.
Outcomes: (1) A local management pathway was proposed to aid appropriate evaluation and timely discharge (2) We will present the first 10 months of data from this new Nurse-led clinic which was started in December 2017, with an average of 6 patients now seen per month.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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