Endocrine Abstracts

Objective: Based on recommendations from the Clinical Practice Guidelines committee group on management of adrenal incidentalomas our project aims to review whether patients found to have adrenal incidentalomas were managed as per recommendations of the committee as follows: If they had a 1 mg overnight dexamethasone suppression test,were they tested for phaeochromocytoma, whether the investigations were used judiciously keeping in view patients co-morbid state, were any of the endocrine tests repeated (as guidelines suggest against repeating) and what was the outcome. We also looked if patients had repeat imaging when guidelines recommend against further imaging for follow-up when adrenal mass is less than four cm with clear benign features on imaging.

Design: Retrospective analysis of patient’s electronic notes found to have adrenal incidentalomas in 2014–2015. (n=24). Standards included measurement of biochemical parameters (potassium, renin/aldosterone ratio, 24 hour urinary catecholamines, ONDST) assessment of radiological features and whether interval scanning took place.

Results: Total of 24 eletronic notes and imaging reports were reviewed. One patient declined further investigations and three patients were not referred to endocrine clinic. Biochemical measurements were performed as follows:

Overnight dexamethasone suppression test: 25%: 24 hour Urinary cortisol: 12.50%

Renin/aldosterone ratio: 70.80%

Urinary catecholamines: 58.33%

66.67 percent of cases had follow up interval scanning (16/24). Out of the 16 who had repeated scanning 13 had size less than 4 cm.Of the 24 cases, one phaeochromocytoma and two possible conns were identified.

Conclusions: This highlights need to develop a pathway for appropriate initial investigation in patients diagnosed with adrenal incidentaloma and ensure investigations are justified. Also need to reduce request for repeat scans in patients found to have incidentalomas that are under 4 cm in diameter and are radiologically benign. There is room to improve the comprehensive investigation of such cases in our practice.