Endocrine Abstracts

Background: Adrenal incidentalomas often pose a clinical conundrum when identified radiologically. The direction of management is often based on findings on imaging and biochemistry. To aid management, the European society for Endocrinology (ESE) recently published guidelines.

Aims and Methods: We conducted a retrospective analysis of 142 patients with identified adrenal incidentalomas between April 2020 and April 2021 in East Kent Hospitals University NHS Foundation Trust to assess whether the imaging modality and reporting, biochemical tests and follow up were in line with ESE guidelines.

Results: Of the 142 cases reviewed, 89 (62%) of cases were referred to the endocrinology department. Adenomas were identified in 122 (85.9%) of cases, with 95 (77.9%) of these adenomas being unilateral. 46.7% of patients had CT of the adrenals with the majority having MRI. Only 27 (47.4%) of CT scans had a Hounsfield Unit (HU) or CT washout indicated in the report. 36 (40.4%) had suspected clinical evidence of endocrinopathy. Majority of the referred cases 51 (57.3%) had biochemical tests with only 17 (11%) having positive results. Plasma metanephrines and 24hr urine free cortisol (UFC) continue to be the main biochemical screening tools with 47 (92.2%) and 37 (72.5%) respectively, and only 23 (45.1%) having an overnight dexamethasone suppression test (ONDST). Follow up biochemistry and imaging were unnecessary in 3.9% and 21.5% of these patients.

Discussion and Conclusion: We identified MRI scans as the main imaging modality and of those who had CT scans, the reporting fell far short of the reporting guidance. Plasma metanephrines and 24hr UFC still appear to be the main biochemical screening tools with only a minority performing ONDST. These results highlight the need to raise awareness of current guidance around imaging and biochemical work up. This has the potential to reduce inappropriate use of investigations for screening and follow up.