Endocrine Abstracts

Background: In November 2017, a nurse-led Adrenal Incidentaloma (AI) clinic was launched at the University Hospital of Wales (UHW), Cardiff, based upon the 2016 European Society of Endocrinology AI management guidelines.

Objectives: To evaluate the effectiveness of a nurse-led clinic in managing AI patients at UHW.

Methods: Retrospective analysis of electronic records of patients seen in the nurse-led AI clinic over a 5-year period, December 2017-November 2022. The number of patients assessed, initial radiological scan characteristics, investigations ordered, management, waiting and discharge times, and final diagnoses were evaluated.

Results: 316 patients with adrenal masses were assessed. The mean age was 64y, 43.7% male and 56.3% female. Referral routes: Most patients (39.9%) were referred by Primary Care. CT AP (29%) and CT TAP (24%) detected most lesions initially. Scan characteristics: 84.8% unilateral nodules, 11.4% bilateral nodules, 2.2% unilateral hyperplastic lesions and 1.6% bilateral hyperplastic lesions. 94.3% lesions were 1-4cm in size. Investigations ordered: 81% had Overnight Dexamethasone Suppression Test (ODST), 83% had urinary metanephrines measurement, 54% had an Aldosterone: Renin Ratio and 85% had at least one repeat imaging. 17% hormonal investigations and 4% repeat imaging requests were not completed by patients. Final diagnoses: made in 221 patients: 196/221 (88.7%) were non-functioning, 21/221 (9.5%) had Autonomous Cortisol Secretion, 2/221 (0.9%) Cushing’s, 1/221 (0.45%) Conn’s, 1/221 (0.45%) phaeochromocytoma. No adrenocortical carcinomas found. Patient flow: 219/316 (69.3%) AI patients have been discharged from the service, with discharged patients only attending a mean of 1.03 medical-doctor led clinics. Waiting times for clinic assessment have doubled from 103 days in 2017 to 232 days in 2022. Similar trends are seen in Discharge times.

Conclusions: A large proportion of AI patients can be effectively assessed and discharged through a nurse-led service, with majority of lesions found to be non-functioning and 69.3% having been discharged.