ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 65 P69 | DOI: 10.1530/endoabs.65.P69

Adrenal incidentaloma multi-disciplinary investigation and management at University Hospitals of Derby and Burton Foundation Trust

Amy Morrison1, Ye Lynn Ko2, Adnan Agha2, Rathy Kirke1, Suma Sugunendran1 & David Hughes1

1Royal Derby Hospital, Derby, UK; 2Burton Hospital, Burton, UK

Introduction: Incidental indeterminate adrenal nodules discovered on imaging in patients under the care of University Hospitals of Derby and Burton Foundation Trust are discussed in Urology MDT. MDT cases were reviewed for a 12 month period before an endocrinologist joined the MDT in January 2018 and 12 months afterwards, to review the compliance of local practice with European Society of Endocrinology (ESE) Guidelines for the management of adrenal incidentalomas.

Results: 45 patients had adrenal nodules (12–160 mm in maximum diameter) discovered on abdominal imaging; CT (n=41), MRI (n=2), MRCP (n=1), CTA (n=1), with HU >10 in 84% of cases (n=38). 39 patients had a unilateral nodule (Right n=14, Left n=25) with bilateral adrenal nodules in 6 patients. Adrenal nodule was associated with malignancy in 27% (n=12) of these patients, with metastatic disease diagnosed from primary lung (n=3), RCC (n=1) and DLCBC Lymphoma (n=1) as well as primary adrenal malignancy; sarcoma (n=1) and adrenocortical carcinoma (n=1). Investigation of hormone excess was carried out (Table 1). Non-functioning incidentaloma were diagnosed (n=21), the most common active nodule found was Phaeochromocytoma (n=6), Aldosterone secreting (n=2) and Cortisol secreting (n=1). 27% (n=12) of patients were scheduled for, or had undergone adrenalectomy.

Table 1
Differential DiagnosisAssessment2017 (%)2018 (%)
Clinical evidence of hormone excessOutpatient Clinic review by endocrinologist6 (29)19 (79)
PhaeochromocytomaPlasma or Urine Metadrenalines12 (57)18 (75)
Cushings9AM ACTH, Overnight Dexamethasone Suppression or 24 hr Urine Cortisol5 (24)15 (63)
Adrenocortical CarcinomaSteroid precursors-DHEAS, 17-OHP3 (14)11 (46)
ConnsRenin and Aldosterone5 (24)10 (42)

Conclusion: Local review of adrenal incidentaloma cases, following introduction of an Endocrinologist to MDT, argues for an improved and comprehensive assessment with particular reference to functional lesions. Implementation of a structured local guideline, may improve ESE adherence, to optimise management of functional adrenal incidentalomas.

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