Endocrine Abstracts

Incidental adrenal masses is a common finding on abdominal imaging completed for other reasons. Majority of these masses are benign non-functioning adenomas. Investigations are required to ensure they are benign and do not have autonomous hormonal secretion.

Aim: We completed an audit to review current practice in the assessment of adrenal incidentaloma at our organisation, a mid-size acute DGH, and compared it with European Society of Endocrinology (ESE) Clinical Practice Guideline 2016, on management of adrenal incidentalomas.

Methods: A search of CT and MRI report database with the key words ‘adrenal adenoma’ and ‘adrenal mass’ from January 2014 to December 2015 was used to identify patients. Patients with previous adrenal history were excluded. Relevant clinical data was identified by reviewing electronic patient records. A total of 231 patients were included in our audit.

Results: 2/3rd of the imaging reports described features consistent with benign adenomas. 26% of cases were further investigated with repeat imaging and only 18% of cases had hormonal testing completed.

Discussion: The purpose of further evaluation of incidental adrenal findings is to exclude any functionally active or malignant tumours. Our results show that a large proportion of patients with adrenal incidentalomas did not have investigations to exclude autonomous hormonal secretion as recommended by the ESE guidelines, and a quarter of patients had repeat imaging despite benign appearances on initial imaging. This audit identified the need to develop a local policy for investigating incidental adrenal findings by non-specialists and setting up a dedicated MDT service to streamline further investigations and management.