Endocrine Abstracts

Introduction: There is an increased number of referrals to endocrinology for adrenal nodules found on imaging. This is due to increased use and advancement in imaging modalities. Adrenal nurse-led clinics are cost-effective and safe. We established an adrenal nodule nurse-led clinic at Northwick Park Hospital in September 2022.

Methods: Retrospective data collection and analysis of patients reviewed at the clinic between September 2022-2023.

Results: Twenty-Nine patients (M=12/F=17) were seen. Twenty (69%) patients had left-sided adrenal nodules, five (17%) patients had right-sided adrenal nodules and four (14%) patients had bilateral adrenal nodules. Mean nodule size was 1.9 cm (range= 1.0-8.8, SD=1.6). Four (14%) adrenal nodules were ≥ 4 cm. Waiting time from initial referral to clinic review was 41.5 days (SD=29.9). Fourteen (48%) patients had hypertension, thirteen (45%) had diabetes and none had hypokalaemia. Non-functioning benign adrenal adenoma was diagnosed in seventeen (59%) of patients, primary hyperaldosteronism in three (10%), mild autonomous cortisol secretion in two (7%), myelolipoma in one (4%), Cushing’s syndrome in one (4%) patient, while five (16%) patients still remain under investigation. All patients were subsequently reviewed at the endocrinology consultant-led clinic. Eleven (38%) patients were discussed at the local endocrine multidisciplinary meeting. Ten patients (34%) were directly discharged after their first consultant-led consultation, whilst three (10%) were referred to a tertiary centre for further endocrine investigations. The remaining patients were followed-up locally and four (14%) were discharged after a second consultant appointment, whilst the rest required further endocrine testing.

Discussion and conclusions: We compared our performance to the literature. The number of patients referred to our adrenal nurse-led clinic each year, the size of adrenal lesion and the final diagnosis was comparable to other centres. The timeframe from referral to clinic appointment was shorter in our clinic compared with another centre in the UK (41 days vs 3.6 months). The shorter time to testing may reduce anxiety in patients. All patients in our clinic were subsequently reviewed at a consultant-led clinic before they were discharged, whilst in other centres patients are directly discharged from the nurse-led clinic. This audit shows the importance of a local adrenal nurse-led practice that is appropriate for assessment of patients with benign adrenal nodules, facilitating early patient review, endocrine dynamic testing and prompt discharge of patients with adrenal incidentalomas, that enables reduced clinic visits and faster access to testing, using a standardised algorithm in line with the European Society of Endocrinology guidelines.