Audit on the management of adrenal incidentaloma
Sumudu Bujawansa & David Bowen-Jones
Introduction: Adrenal incidentaloma is defined as a clinically inapparent adrenal mass that is incidentally detected after imaging studies conducted for reasons other than the evaluation of the adrenal glands. Existing guidance suggests that excess catecholamine and cortisol secretion should be ruled out all cases and excess aldosterone secretion should be ruled out hypertensive patients. Certain features on CT scanning such as a Hounsfield value of over 10 are useful in differentiating between incidentaloma and other lesions. In addition repeat evaluation after a period of time is suggested.
We audited how adrenal incidentaloma are investigated in a large district general hospital in the North West of England.
Method: We reviewed abdominal CT scan reports from 2694 patients who had their scans between August 2007 and February 2010. Patients with adrenal incidentaloma were identified and their clinical records were reviewed.
Results: Adrenal incidentaloma were reported in 93 patients giving rise to an approximate prevalence of 3.45%. Thirty-four of the scans were requested by physicians.
Forty-five percent of the lesions were left sided and 26% had bilateral lesions. The size of the lesion was reported in 68 scans with the largest being 6 cm. The average size was 1.68 cm. The Hounsfield value was reported in 13 scans and it was more than 10 in 6 scans.
Only five patients had excess catecholamine secretion ruled out and only three had excess cortisol secretion ruled out. Only two patients had excess aldoseterone secretion ruled out.
Only twelve patients had repeat imaging done and only three had their biochemistry repeated.
Discussion: Adrenal incidentaloma are inadequately managed by non specialists. The quality of radiology reports with regard to Adrenal incidentaloma is inadequate.
This deficiency may be improved by increasing the awareness of the importance of investigating these lesions amongst non-endocrinologists.