SFEBES2023 Poster Presentations Adrenal and Cardiovascular (78 abstracts)
The investigation and management of adrenal incidentalomas at guy’s and St Thomas’s NHS foundation trust
Nirali Desai , Shravan Gowrishankar , Alexander Hodson , Catherine Santucci , Isabel Demel , Benjamin Zuckerman , Panagiotis Armonis , Dimitra Christodoulou , Anand Velusamy , Paul Carroll & Aaisha Saqib
Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Background: Rapid improvements in imaging have led to a 10-fold increase in the incidence of adrenal incidentalomas (AIs) over the past two decades. Delays in the diagnostic evaluation of AIs are associated with patient anxiety and significant burden on medical resources. We retrospectively audited the investigation and management of AIs at Guy’s and St Thomas’s NHS Foundation Trust (GSTT).
Methods: Patients with newly identified adrenal incidentalomas, discussed at the weekly adrenal multidisciplinary team meeting (MDM) at GSTT between 1st January to 31st March 2022, were reviewed. Data was collected by using Electronic Patient Record and e-Noting.
Results: Of the 139 patients discussed, 100 patients were excluded (non-adrenal pathology, referral due to abnormal investigations, re-referrals); therefore 39 patients were included in data analysis. 82% of patients were referred to the MDM by endocrinology; the remaining referrals were from non-endocrine specialties including urology and gastroenterology. 48.7% of patients had a non-functioning adenoma, 30.8% of patients had a functioning adenoma. The table shows the proportion of functional tests sent before the MDM discussion by endocrinology and non-endocrine specialties:
| Percentage of tests sent by endocrinology (%) | Percentage of tests sent by non-endocrine specialty (%) | |
| Plasma/Urinary Metanephrines | 56.3 | 14.3 |
| Aldosterone-Renin Ratio | 71.9 | 14.3 |
| Urinary Steroid Profile | 3.1 | 14.3 |
| Overnight Dexamethasone Suppression test | 71.9 | 0 |
Conclusion: Our results highlight a significant disparity in the proportion of functional tests sent off by non-endocrine specialties before the MDM in comparison to endocrinologists. This has subsequently led to delays in decision-making about the management of AIs. We intend to implement a Trust-wide A4 guideline aiming to educate non-endocrine teams on how to initially investigate AIs. This would therefore increase the proportion of functional tests performed before MDM referral, and improve the efficiency of the AI pathway at GSTT.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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