It is important to identify whether benign adrenal incidentalomas are hormonally active. Traditionally, investigations were arranged during the first medical consultation and relied heavily on the patient remembering a considerable number of instructions. The patient was required to collect urine bottles from pathology, a prescription from pharmacy and perform multiple tests including renin, which was often incorrectly performed in outpatients. Due to the cumbersome nature of investigations performed during an outpatient clinic, we have tried to streamline tests prior to the first outpatient consultation. Adrenal incidentaloma referrals and imaging are reviewed to ensure they have a benign appearance and passed to the Endocrine Specialist Nurses, who organise a day-case nurse consultation. All the investigations are explained in detail by the nurse and a 30 minute recumbent renin and aldosterone, along with U&Es are performed. Two 24 hour urinary metanephrine collections and a 1mg overnight dexamethasone suppression test are arranged. Bottles, forms, medication, information leaflets and contact details are given to the patient. We audited this strategy in 29 patients with adrenal incidentaloma. The interval between CT scan and endocrine referral letter was [median (range)] 49 (0513) days, interval from referral letter to nurse tests 19 (153) days, interval from nurse tests to all tests being completed 7 (150) days, interval from nurse tests to initial consultant appointment 37 (4106) days, interval from endocrine referral to all test completed 27 (692) days. All tests were completed in 97% of the patients. One patient failed to undertake any tests. Arranging these investigations in parallel whilst awaiting an outpatient consultation, allows for the results to be available when the patient attends outpatients, reduces consultation time, increases the reliability of the tests being performed and also carries a day case tariff for the trust.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.