Endocrine Abstracts

Background: We have seen an increased referrals to endocrinology because of adrenal lesions that are discovered on imaging performed for other clinical indications. This is largely driven by the increased use of, technological advancement in imaging modalities, and increasing prevalence of chronic disease. We performed an audit to determine the incidence of adrenal incidentalomas at a large general hospital and to assess management of adrenal incidentalomas in relation to the European Society of Endocrinology (ESE) guideline.

Method: We reviewed data of patients who were found to have adrenal lesions on imaging from December 2020 to December 2021. CT and MRI reports were reviewed, and relevant clinical data were reviewed on electronic patient records.

Results: Thirty-seven patients were identified to have adrenal lesions discovered incidentally on imaging. 15 males and 22 females with mean age 41.5 and 59.3 years respectively. Out of 37 patients, two patients passed away for other reasons before they could be referred. 35 patients were seen in endocrine clinic. Non-functioning benign lesions were diagnosed in 18 patients (51%). Remaining 17 patients: 2 (6%) had phaeochromocytoma, 1 (3%) had cortisol secreting adrenal adenoma and 3 (9%) had possible autonomous cortisol secretion. Eight (23%) with indeterminate adrenal masses and normal hormonal assessment underwent follow-up repeat imaging, these did not show any growth/change. 3 (9%) failed to attend for their investigations.

Conclusion: Our findings were in accordance with the ESE guideline. A multidisciplinary approach is required for effective management of adrenal nodules. The majority of adrenal incidentalomas were benign and non-functional and such patients can be reassured and discharged. Complete personalised endocrine workup and assessment of symptoms and signs is required for each patient, along with discussion in an adrenal MDT. We have established a nurse-led adrenal clinic to ensure referrals receive appropriate endocrine testing.