SFEBES2023 Poster Presentations Adrenal and Cardiovascular (78 abstracts)
Presentation and management of adrenal tumours over time: a real-life experience from a UK tertiary care centre
Onnicha Suntornlohanakul 1,2,3,4 , Sumedha Mandal 3 , Pratyusha Saha 3 , Shadman Ahmed 3 , Jessica Parkin-Crawshaw 3 , Miriam Asia 2 , Wiebke Arlt 1,2,3,5 , Yasir Elhassan 1,2,3 , Alessandro Prete 1,2,3 & Cristina L. Ronchi 1,2,3
1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. 2Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. 3Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom. 4Endocrinology and Metabolism Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. 5Medical Research Council London Institute of Medical Sciences, Imperial College London, London, United Kingdom
Background: Adrenal tumours are found in 3-7% of adults. The European guidelines on management of adrenal incidentalomas (first published in 2016 and recently updated) have standardised the management of these patients, but evidence of guideline impact on clinical care is lacking.
Methods: Retrospective review of the mode of presentation, radiological characteristics and final diagnosis of a large cohort of patients with adrenal tumours referred to a UK tertiary centre between 1998 and 2022.
Results: We included 1398 patients (55.7% women; median age 60 [interquartile range, IQR, 49-70] years; n=407 evaluated before and n=991 after implementing the guidelines). Incidental discovery was the most frequent mode of presentation (63.7%). Overall, 14.6% patients had bilateral tumours and 30.7% had tumours ≥4 cm (median 2.9 cm (IQR 1.9-4.7)). Unenhanced CT Hounsfield Units (HU) were available for 763 patients; of these, 32.9% had heterogeneous tumours or HU>20. After standardised work-up, the most common diagnoses were adrenocortical adenoma (ACA, 55.9%), phaeochromocytoma (13.3%), adrenocortical carcinoma (10.6%), and metastases of an extra-adrenal primary cancer (5.7%). Reassuringly, nearly half of the patients (47.5%) referred for indeterminate lesions were eventually diagnosed as having ACAs. At multivariable regression analysis, HU>20 or heterogeneous tumour was most powerful in discriminating malignant from benign lesions (adjusted Odd Ratio, OR, 29.57), followed by discovery during cancer surveillance (OR 10.56), tumour size ≥4 cm (OR 6.10) and presence of hormonal or localising symptoms (OR 3.30). Following the publication of the guidelines, the proportion of follow-up visits in patients with non-functioning ACAs decreased from 89.6% to 69.9%, while the proportion of patients discharged from the clinic increased from 4.3 to 25.3% (P<0.05).
Conclusion: We provide an extensive retrospective review of patients referred and worked-up for adrenal tumours. The implementation of the European 2016 guidelines positively impacted clinical practice, reducing the number of unnecessary investigations and surgeries.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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