Endocrine Abstracts

We audited the management of adrenal incidentaloma (AI) in our hospital.

29 patients (12 male) were referred with AI, mean age 68y (48–87 years). Mode of detection: 7 ultrasound (2 no mass on subsequent CT/MRI), 20 CT, 1 MRI and 1 lumbar XR. Site of tumour: 18 right, 7 left, 1 bilateral, 1 N/A. Size: <4 cm in 17, 4–6 cm in 4, >6 cm in 2, “large” in 1, not stated in 4. History: 8 had clinical features of possible hormone excess. 6 had functioning tumours: 2 Conn’s, 4 subclinical Cushings (SCS). 1 was adrenal carcinoma.

Endocrine tests undertaken in 27 cases: U&E 27, UFC 15 (1, 2 & 3 samples in 9, 2, & 4 cases), Urinary catecholamines 19 (1, 2 & 3 samples in 8, 6 & 5), Testosterone 14, 17-OH-progesterone 1, DHEAS 10, androstenedione 11. Random cortisol 10. 48 h low dose dexamethasone suppression 12, overnight dexamethasone suppression 1, ACTH 2, CRH test 1 and SST 3.

3 of 6 lesions >4 cm proceeded to surgery compared to 2 of 17 lesions <4 cm (1 Conn’s, 1 SCS). After surgery 3/5 had post-op SST but none required hydrocortisone.

Of 22 cases managed conservatively follow-up plans recorded were: Radiology: repeat scan at 6 months in 2 and 1 year in 5, ad hoc plan each visit in 2, no plan in 5, too unwell to repeat in 3, surgery/oncology referral in 1. Endocrine testing: specific plan not to repeat tests in 3, ad hoc monitoring in 2, repeat UFC 1 year in 3, no plan in 14.

Investigation of AI was variable and in many cases a management plan was not stated or ad hoc. AI should be investigated/managed by endocrinologists, developing consistent protocols for investigation/management and documenting a clear follow-up plan in the patient records.