SFEBES2023 Poster Presentations Adrenal and Cardiovascular (78 abstracts)
1University of East Anglia, Norwich, United Kingdom. 2Norfolk and Norwich University Hospital, Norwich, United Kingdom
Background: Adrenal incidentalomas (AIs) detected on pre surgical scans often present a logistical challenge due to the pressing need for preoperative exclusion of a phaeochromocytoma. Our local guideline recommends endocrinology referral for all AIs for further investigations, including pre clinic 24-hr urine metadrenalines. This approach can be time-consuming, particularly for patients awaiting unrelated surgery.
Methods: Our review included all AIs identified within our centre over a 2-year period (from 1/1/2021 to 31/12/2022). All AIs underwent unselected screening for phaeochromocytoma, including urine metadrenaline (MN) & normetadrenaline (NMN) analysis, followed by measurements of plasma MN and NMN concentrations in those with raised 24-hr urine MN/NMN concentrations.
Results: Initial analysis revealed 13 patients with elevated 24-hr urine NMN or MN levels, with 5 patients confirming elevated levels on 2 separate occasions. Subsequently only 2/13 (15.4%) patients had confirmed raised plasma normetadrenaline and/or metadrenaline concentrations, suggesting possibility of a phaeochromocytoma. On retrospective review, both these patients also had an AI with raised HU (>10 HU; recommended diagnostic threshold for pheochromocytoma screening for AIs).
Patient number | Gender | Age (yr) | 24-hr urine NMN (F ≤ 3.0 µmol/24hr; M ≤3.8 µmol/24hr) | 24-hr MN (F ≤1.8 µmol/24hr; M ≤2.2 µmol/24hr) | Plasma NMN (<1180 pmol/l) | Plasma MN (<510 pmol/l) | HU |
1 | F | 66 | 5.1 | 0.5 | 1201 | 99 | 40 |
2 | M | 72 | 6.9 | 6.7 | 1392 | 797 | 22.3 |
Conclusion: Our ongoing review aims to validate the guidance that early adoption of the HU approach as an initial screening tool for adrenal incidentalomas is cost-effective and clinically safe. However, practical application of this approach requires a standardised multidisciplinary assessment for all AIs including careful evaluation of all imaging, prior to undertaking endocrinology assessment, to optimise resource utilisation in clinical practice.