Endocrine Abstracts

Background: An adrenal incidentaloma (AI) is an adrenal lesion found on imaging performed for an indication other than adrenal disease. The current European Society of Endocrinology guidelines recommend that all AIs are discussed in a dedicated adrenal multidisciplinary meeting.

Method: We evaluated the outcomes of AI cases referred to the Adrenal Radiology Meeting (ARM) at Heartlands Hospital between January 2021 and December 2021 using a local database. Imaging reports, as well as clinical and laboratory data were reviewed.

Results: 178 patients were referred from different specialities across the Trust for discussion in the ARM. The mean age of patients in this cohort was 64 years, of which 56% were female. 75% of patients (134/178) had benign, non-functional adrenocortical adenomas or other benign lesions, such as myelolipoma (6 patients). Three patients were diagnosed with unilateral adrenal haemorrhage. Hormonal evaluation was carried out for 98/178 (56%) patients, of which 52 patients had an indeterminate lesion by imaging. 23 of these patients had raised normetadrenaline results, of which 2 had confirmed phaeochromocytoma by MIBG scan and post-operative histology. 29/98 (30%) patients failed the overnight dexamethasone suppression test (ONDST); 2 had ACTH-independent Cushing’s syndrome, 6 had definitive and 21 had possible mild autonomous cortisol secretion. 22/29 patients that failed the ONDST had relevant, associated co-morbidities including diabetes mellitus, hyperlipidaemia, hypertension and obesity. Two patients had non-classic congenital adrenal hyperplasia (CAH) and one had adrenocortical carcinoma. There was no biochemical diagnosis of Conn’s syndrome.

Conclusion: Each patient with an AI should be discussed in an adrenal meeting/MDT and undergo a clinical and biochemical assessment. Although, the majority of patients with AIs have benign non-functional lesions, a small percentage of patients have functional lesions that often require surgical treatment and should not be missed.