Adrenal incidentalomas is a common referral to endocrine department. We retrospectively looked at the number of referrals to the endocrine services with it over 1 year and their eventual outcomes. There were a total of 37 patients referred with adrenal incidentalomas to our department out of which 28 patients (76%) were non secretory, while 1 (3%) had catecholamine excess. 1 (3%) had mixed cortisol + catecholamine excess. 7(19%) patients either did not attend clinic or lost follow up. Most of the patients (2977%) were in 5th-7th decade of life on their 1st visit to us. 30 (79%) incidentalomas size was <4 cms, 4 had size 3-3.9 cms and 3 >4 cms. There was no correlation between size and surgical outcomes. 2 patients who were secretory were >4 cms in size. 25 patients (68%) had CT reported as <10 HU, 6 (16%) had >10 HU requiring further imaging and 6 (16%) were not reported in HU. While investigating the secretory nature of the lesions we found that for most of the patients we carried out appropriate tests but we under investigated 3 patients as only 9 am cortisol was checked for 2 patients and no secretory tests carried out for 1. On the other hand we over investigated 11 patients as Aldosterone-Renin Ratio was checked for 10 normotensive patients and 1 patient had DHEA levels checked without appropriate reason. For the 37 patients referred to us, 25 eventually got discharged (68%), 4 got operated (11%), 4 lost follow-up (11%), 3 died due to other reasons (8%) and 1 is still on active follow-up (3%).
Conclusion: Majority of the patients referred for adrenal incidentalomas would be non-secretory, benign in appearance and most of them would be discharged without need for further follow-up. And we have to use the resources and guidelines wisely, taking care not to over investigate the patients whilst not under investigate at the same time.