Endocrine Abstracts

Aim: This is a retrospective study of imaging with adrenal incidentalomas at our DGH to assess clinical practice. Their management was followed and compared with the European Society of Endocrinology (ESE) Clinical Practice Guidelines 2016 for management of adrenal incidentalomas. The aim was to improve clinical service by developing a local management pathway.

Materials and Methods: Data was collected for two years from 2018 to 2019 which included all images with an incidental adrenal adenoma. Out of 191 patient’s scans, 168 were selected as appropriate, and their clinical records were reviewed.

Results: 30% of the reports did not mention the size of the adenoma and among the 47 dedicated adrenal scans, 27% did not have a Hounsfield Unit (HU). Only 36% of all scans were referred to endocrinology for investigation hence it was possible to ascertain that only 2.38% were functional, but the functionality of 71% adenomas was unknown. 29% had repeat imaging done. 22 scans showed bilateral adenomas, and only half of them were referred for further work up. We were also able to determine the characteristics of the 4 functional adenomas. These findings further confirmed that radiologically benign adenomas can be functional.

Conclusion: This audit identified the need to develop a local management pathway for adrenal incidentalomas at our hospital. We liaised with the urologists and the radiologist to create a pathway, which involved investigations as recommended by the ESE, a reporting guide for the radiology department, and the criteria for referral to the local or tertiary surgical team. This pathway was presented at the department clinical governance meeting, and subsequently was approved at the Medicine Divisional Governance Group meeting. The pathway is now available for reference on the hospital intranet.