Endocrine Abstracts

Introduction: An adrenal incidentaloma is an adrenal mass lesion greater than 1 cm in diameter, which is incidentally discovered by radiological investigation. The prevalence of adrenal incidentalomas increases with age, increasing to around 3% at aged 50years and 10% in the elderly. The majority of these lesions are benign >80%. Adrenal incidentalomas fall into one of three categories: Non-functioning tumours: these lesions are benign e.g. adenomas, adrenal cysts, haematomas, etc. Functioning tumours: these lesions produce excess of hormones that the adrenal gland normally produces such as in phaeochromocytoma, Cushing’s, Conn’s, etc. Malignant tumours: these could include adrenocortical carcinoma and metastatic disease.

Aim: of this study was to look at the diagnosis and management of patients referred for adrenal incidentalomas at Queen’s Hospital, London, UK (BHRUT–Barking, Havering and Redbridge University Hospitals NHS Trust) in 2014-2020 (7 years).

Method: Retrospective single-centre study looking at patients referred for adrenal incidentaloma between 2014-2020. 154 patients were identified and data was collected on investigations, diagnosis and management. This was compared to the European Society of Endocrine guidelines 2023.

Results: 154 patients identified of which 61% female and 39% male. Initial scan showing adenoma leading to referral were CT 84% and MRI 16% Age of presentation more common in the age range of 61-70years (30%) and the least common was age range 20-30years (1%). Majority of the adrenal incidentalomas were non-functioning (65%). The second most common was cortisol secreting adenomas which included 28 patients with 21 possible autonomous cortisol secreting adenomas (PACS) and 7 autonomous cortisol secreting adenomas (ACS). Looking further at these patients and their co-morbidities such as hypertension, diabetes mellitus, dyslipidaemia; 100% had dyslipidaemia and 81% of PACS and 57% ACS had 2 or more co-morbidities. The remaining adrenal incidentalomas consisted of 8% Conn’s, 4% Cushing’s, 3% Phaeochromocytoma, 3% myelolipoma, 3% malignancy and 5% had no diagnosis. No diagnosis was either due to patient’s wishes for not having further investigations or patient passed away before completing investigations.

Conclusion: Our single-centre study showed that majority of adrenal incidentalomas are non-functioning (65%) which correlates with the literature. However, it is important not to miss relevant diseases such as phaeochromocytoma, adrenocortical carcinoma, etc. It is important to send relevant investigations including hormone profile. It is important to have an MDT approach which is individualised for each patient.