Introduction: Adrenal incidentalomas are increasingly found in patients imaged for investigation. A service evaluation was undertaken to standardise care for these patients in line with the European Society of Endocrinology Guidelines.
Aim: Standardise the care for patients with adrenal adenomas at Royal Liverpool University Hospital.
Method: Retrospective review of 70 patients with adrenal incidentalomas over 2 years (January 2016December 2018).
Results: 70 patients with 86 adrenal adenomas (16 bilateral) were included. 87% were found incidentally, 6% had adrenal specific symptoms and 7% were known to have adenomas already. The associated comorbidities were hypertension (57%), cardiovascular disease (36%), diabetes (21%) and osteoporosis (4%). 21% had no comorbidities. 69% were picked up on CT and 31% on MRI. There was consistency in MRI reporting with 89% referencing signal dropout on reports but only 25% CT reports had specific hounsfield units. 42% of the lesions were <2 cm, 51% 24 cm and 7% >4 cm. 91% were reported as benign, 7% indeterminate and 2% as heterogeneous requiring surgery but were benign on histology post-surgery. Cortisol, aldosterone and metadrenalines hormones were assessed in; 90%, 87% and 89% respectively and sex hormones in 44% of the patients as this were only checked in females appropriately. 43% patients were initially referred to endocrine surgery, 37% to endocrinology, 11% were under both specialities and 9% patients were not referred to either. 61% of the patients were still being followed up. 20% for inconclusive biochemical findings, 11% for inconclusive radiology, and 5% awaiting investigations. 25% were followed up despite the adenomas being reported as benign and hormonal screening being negative.
Conclusion: To avoid overinvestigation and medicalization of patients, and for best use of resources, a streamlined audited pathway is necessary as cases originate in a wide variety of departments.