SFEBES2023 Poster Presentations Adrenal and Cardiovascular (78 abstracts)
1University of Birmingham, Birmingham, United Kingdom. 2Queen Elizabeth Hospital, Birmingham, United Kingdom. 3Medical Research Council London Institute of Medical Sciences, London, United Kingdom
Introduction: Up to 3-7% of adults have an adrenal incidentaloma. These are most frequently non-functioning adenomas (NFA) but can be associated with adrenal hormone excess. According to the ESE-ENSAT guidelines on adrenal incidentalomas (2016), an accurate endocrine work-up is recommended.
Methods: We provide an extensive retrospective analysis of patients with adrenal tumours referred to a large UK tertiary centre between 1998 and 2022, with focus on non-aldosterone producing adrenocortical adenomas (NAPACA) and the relationship between hormonal secretion patterns and demographic characteristics.
Results: Our cohort consisted of 1398 patients (56% women, median age at diagnosis: 60 years [IQR 49-70]). Adrenocortical adenomas (ACA) accounted for majority of tumours (56%, n=782); of these, 90% (n=706) underwent full endocrine work-up including overnight dexamethasone suppression test. While most patients had NFA (51%), the others most frequently had mild autonomous cortisol secretion (MACS, 32%), followed by primary aldosteronism (10%) and Cushings syndrome (CS, 4%). Most patients with NAPACA were women, with a higher proportion among those with CS (61% in NFA, 60% in MACS, 87% in CS, P<0.05). Moreover, patients with CS were younger (NFA median 60 years [IQR 51.5-68], MACS 67 years [IQR 58-74], CS 44 years [IQR 30.5-54.5], P<0.05). There was no significant difference in availability of endocrine work-up or proportion of diagnosed autonomous cortisol secretion between patients referred before (1998-2015) or after the publication of the ESE-ENSAT guidelines (2016-2022).
Conclusion: In our large cohort of patients referred for adrenal tumours, full endocrine work up was available in 90% of ACAs and showed presence of autonomous cortisol secretion in 36% of cases. Patients with CS were more frequently younger females. These figures did not change after the implementation of the 2016 guidelines.