Endocrine Abstracts

An endocrine specialist pharmacist has been running an adrenal incidentaloma clinic since September 2020. As of Jun-22 258 patients have been seen in clinic and managed using a local protocol. Adrenal incidentaloma patient referrals are screened as per current guidelines on receipt; those measuring <1 cm are declined, suspected adrenocortical carcinomas are seen by a consultant and referred elsewhere if needed. All others are seen by the endocrine pharmacist within 4 weeks of referral. At the first appointment standard investigations are initiated – urine catecholamines and overnight dexamethasone suppression test (ODST) for everyone, aldosterone renin ratio (ARR) for anyone with a history of hypertension or has had episodes of hypertension in the past. All patients are followed up 3 monthly unless an alternative time frame is appropriate or their investigations are complete. Once results are back: Abnormal urine catecholamines: repeat sample requested and patient referred to adrenal MDT Abnormal ODST: 24 hour urine free cortisol arranged Abnormal ARR: interfering medications switched to suitable alternatives and test repeated; confirmatory tests are arranged as needed. Once the clinical picture is clearer the case is discussed at local adrenal MDT. The endocrine pharmacist manages the MDT list and decides which patients need discussing. After the MDT the pharmacist contacts all patients and the outcome conveyed. Patients with active nodules are transferred to consultant care or discussed with tertiary MDT. The endocrine pharmacist manages the list for presenting to the tertiary MDT ensuring all results and clinical information is available and imaging transferred. Since the endocrine pharmacist has been in post the service has been streamlined and managed efficiently. Patient outcomes: 52 active, 27 transferred to consultant care, 13 referred to tertiary care, 159 discharged, 3 died, 4 DNA discharged. Dynamic function testing is more efficient; improved relations with the day care team is assisting this.