Endocrine Abstracts (2007) 13 P59

How do we manage adrenal “incidentalomas” – an audit of referrals to a teaching hospital endocrine unit

Kath Higgins, Miles Levy & Trevor Howlett


Leicester Royal Infirmary, Leicester, United Kingdom.


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.

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