Endocrine Abstracts

The widespread use of cross-sectional imaging has led to increased detection of adrenal masses in 2% of general population and over 7% of those above age 70. Although majority are benign, it is important to exclude hormonally active or malignant lesions. Mild autonomous cortisol secretion (MACS) is the most common and found in 30-50% of patients with adrenal mass. We reviewed our adrenal incidentaloma database for patients who attended the nurse-led pathway for biochemistry investigations followed by medical review. Patients were excluded if investigations were refused or incomplete. We reviewed 516 patients between April 2017 and December 2022. We primarily performed 1mg overnight dexamethasone suppression tests (ODST) and some underwent 24-h urine cortisol collections. A total of 139(27%) patients had abnormal biochemical corticosteroid status(either test abnormal). A total of 465 patients had ODST of which 315(67.7%) were normal, 118(25.4%) had cortisol level between 51-138 nmol/l (MACS-1), 22(4.7%) had cortisol >138 nmol/l (MACS-2) and 10(2.2%) were unassessable. Patients with MACS consist of 46(32.9%) males and 94(67.1%) females. The mean age was 66.9 years. Seventy-three(52%) have hypertension, 31(22%) type 2 diabetes, 7(5%) osteoporosis and 2(1.4%) vertebrae fracture. Seventy-six patients (54.3%) were screened for diabetes with normal results, 9(6.4%) abnormal glucose regulation and 24(17.1%) were not screened. Patients with MACS should be screened and treated for hypertension, type 2 diabetes and asymptomatic vertebrae fracture. Our audit identified the need to improve screening for osteoporosis. These comorbidities are more prevalent in the older age group. It remains a challenge to identify patients who would benefit from surgical intervention, particularly with growing evidence that MACS can adversely impact on these co-morbidities. Increased surgical intervention would have a significant impact on provision of healthcare services and a personalised approach should be advocated.