Introduction: With the increased use of imaging modalities, detection of Adrenal Incidentaloma (AI) has become common.
Aim: We evaluated management of patients with AI to improve service delivery.
Method: Patients with AI referred to our endocrinology outpatient service (20062019). Data was collected from electronic case records and radiology reporting system. Demography, biochemical investigations, time interval between two scans, size of the adenoma, increase in size on the second scan and reported Hounsfield units (HU) with washout period were analyzed.
Results: 49 patients studied (male-19, female-30) with average age 66 years (range 4086). Median size of adenoma 2.2 cm (range 0.74.3). In this cohort, 40(81%) had repeat scan, 3(6%) currently awaiting, 5(10%) not repeated on radiologist based on adenoma characteristics and 2(4%) died before scan was performed. Interval between two scans was 24 months (2 months13 years). 5(10.2%) of patients had increase in size on the second scan and average increase by 0.2 cm (0.00.2 cm). HU and washout period were reported only in 6(12%) of first scan and 12(24%) of second scan. 24-h urine catecholamines and renin:aldosterone ratio performed in 18(36.7%), overnight dexamethasone suppression test (ODST) performed in 20(40%) patients.
Conclusion: There was no consistency in the time interval between two scans and radiology reporting of tumor characteristics. Although 24-h urine catecholamines were performed in all patients, ODST was performed in minority. Implementing appropriate biochemical investigations and standard radiological reporting based on the European Society of Endocrinology guidelines will facilitate propitious management and discharge of patients. This will improve the delivery of care and reduce significant burden on an endocrinology service in a district general hospital setting. Radiology reporting with precise characterization of an adenoma is an important determinant in the management plan. We intend to create awareness amongst our radiology colleagues to standardize reporting.