Endocrine Abstracts

Background: Adrenal tumours are often benign and non-functioning. However, there can be underlying phaeochromocytoma, Conns, adrenal Cushing or even malignancy in some cases. It is therefore imperative that these incidentalomas are promptly investigated once detected and managed accordingly.

Aim: 1. To determine the incidence of adrenal incidentaloma at Gozo General Hospital. 2. To determine the adherence of management of incidentalomas to guidelines recommended by the European Society of Endocrinology.

Methods: A cross-sectional study was performed in one centre during which all CT Trunk, CT Abdomen +Pelvis, CT abdomen and CT-KUB carried out between January 2021 and February 2022 were reviewed for presence of adrenal incidentalomas. Relevant information regarding management was collected, analysed and compared to the European Society of Endocrinology guidelines.

Results: A total of 1458 scans were reviewed and 54 adrenal incidentalomas were detected accounting for about 3.7% incidence. Of these, 47(87.04%) were unilateral and 7(12.96%) were bilateral. Overall, 50 were reported as benign, 1 indeterminate while 3 had malignant features. Only 18(33.3%) of the 54 cases were referred to endocrinology for further investigations. In total, 36 patients were not referred to endocrine clinic; However, 16 of these had a history of extra-adrenal malignancy or were over 80 years. The only case of indeterminate lesion had further adrenal imaging which showed possible phaeochromocytoma or ACC. Of the patients being seen at the endocrinology clinic, the investigation rate of 81-100% depending on indication and type of test appears to be of good performance.

Conclusion: 1. There is a significant incidence of adrenal incidentalomas at 3.7%. 2. The low referral rate to Endocrinology at just 33.3% could be improved on. 3. Patients seen at endocrinology clinic were investigated in keeping with the guidelines of the European Society of Endocrinology.

Keywords: Adrenal, Incidentaloma, Benign