Objectives: Increasing use of scanning has led to a significant increase in detection of adrenal incidentalomas. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons have issued guidelines for evaluation of adrenal incidentalomas in 2009. We audited our current practice at Royal Shrewsbury Hospital against the 2009 guidelines.
Method: Retrospective audit of patients found to have adrenal masses on imaging studies done from January 2010 to July 2011. Audit standards: All patients should undergo evaluation clinically, biochemically and radiologically to rule out hypercortisolism, aldosteronism (if hypertensive), presence of pheochromocytoma or malignancy. Patients who do not fulfill the criteria for surgical resection need radiographic reevaluation at 3 to 6 months and then annually for 1 to 2 years. Hormonal evaluation should be performed at detection and then annually for 5 years.
Result: We found 77 patients with adrenal incidentalomas and excluded 23 who underwent imaging as part of work-up for cancer. The remaining 54 patients were true incidentalomas. Mean age was 68.6 years, 57% were males. Bilateral incidentalomas were present in 12%. Of 22 patients (40.7%) referred to the endocrine team for assessment, 20 (90.7%) had full appropriate hormonal assessment and 2 were felt unsuitable for investigations. Two patients underwent adrenalectomy because the adenoma was more than 4 cm and one because of an aldosteronoma. All patients known to the endocrine team had repeat imaging according to the guideline. Only 11 (55%) patients had their hormonal reassessment done after the one year study period.
Conclusion: This audit suggests that a significant number of patients with adrenal incidentaloma were not referred for endocrine assessment. Those referred to the endocrine team were appropriately managed except for repeat hormonal assessment.
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.