Aims: Prior to 2007, there was no agreed guideline at our hospital for the management of adrenal incidentalomas and referrals to our endocrine service were rare. Following evidence-based guidelines, we have developed a local protocol for the assessment of adrenal incidentalomas. We now report clinical outcomes of adrenal incidentaloma patients referred to our endocrine service since its implementation.
Methods: Using a retrospective analysis we collected data on 47 patients with adrenal incidentalomas presenting to our endocrine service over 3 years (20072010). The patient list was generated by biochemistry records and other clinical data were accessed from medical notes and radiology reports. Audit standards were based on international consensus guidelines (AACE/AAES Guidelines 2009, Young WF. The incidentally discovered adrenal mass NEJM 2007) for the management of adrenal incidentalomas.
Results: With respect to endocrine investigations, of the 47 cases of adrenal incidentalomas identified (age range, 1986 years, 20 males, 27 females) 89% were referred to Endocrinology. 28% were diabetic and 45% hypertensive. 100% underwent urinary measurement of catecholamines, 60% testing of Cortisol axis and 74% testing of Aldosterone secretion. Radiological reporting of size of lesion was present in 100% whereas density measurement in Hounsfield units in only 28%. Mean size of lesion was 3.4 cm (range 1.110 cm). Thirteen (28% of total) of lesions where >4 cm. Adrenalectomy was undertaken in 17%. Hormonally active lesions were identified in 8.7% and included 3 Phaeochromocytomas and 2 sub-clinical Cushings.
Conclusions: Adrenal incidentalomas represent an increasingly common clinical problem. The development of our guideline has led to a significant increase in the referral rate of adrenal incidentalomas and enabled a more systematic endocrine evaluation. Amongst referrals, hormonally-active lesions are relatively common and have been amenable to surgical cure. There are however, areas for improvement in order for our service to comply with international standards of best practice.