SFEBES2021 Poster Presentations Adrenal and Cardiovascular (45 abstracts)
Adrenal Incidentaloma Pathway - A four-year experience at a teaching hospital
Roby Rajan , Shekinah Grace K M Chandy , Parvathy Radhakrishnan , Rachel Paterson , Sebastian Aspinall , Alex J Graveling , Sam Philip & Prakash Abraham
Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Background /Methods: Adrenal incidentalomas pose a significant burden to endocrinology services in assessing the clinical significance of these lesions. Following vetting of the incidentaloma referrals, the patients at our centre are initially seen in a nurse-led clinic for biochemical investigations and to ensure completion of radiology assessment using a structured proforma. This step facilitates efficient patient flow and quicker decision making. The clinical outcomes of the patients evaluated though this pathway are summarised below.
Results: 329 patients were seen in our endocrine unit between February 2017 and February 2021. 65.4 % (215) were females and 34.6% (114) males. The mean age was 63.8 ± 12 years.
| Adenoma Laterality | ||
| Left | 190 | 57.8% |
| Right | 81 | 24.6% |
| Bilateral | 58 | 17.6% |
| Adenoma Laterality | ||
| Left | 190 | 57.8% |
| Right | 81 | 24.6% |
| Bilateral | 58 | 17.6% |
| Radiology Outcomes | ||
| Benign | 273 | 83% |
| Indeterminate | 52 | 15.8% |
| Metastases | 4 | 1.2% |
| Radiology Outcomes | ||
| Benign | 273 | 83% |
| Indeterminate | 52 | 15.8% |
| Metastases | 4 | 1.2% |
| Diagnosis | ||
| Benign NFA | 289 | 87.8% |
| Phaeochromocytoma | 4 | 1.2% |
| Autonomous adenoma | 4 | 1.2% |
| Adrenal cancer | 1 | 0.3% |
| Metastases | 3 | 0.9% |
| Awaiting confirmation | 28 | 8.5% |
| Diagnosis | ||
| Benign NFA | 289 | 87.8% |
| Phaeochromocytoma | 4 | 1.2% |
| Autonomous adenoma | 4 | 1.2% |
| Adrenal cancer | 1 | 0.3% |
| Metastases | 3 | 0.9% |
| Awaiting confirmation | 28 | 8.5% |
| 1 mg Overnight Dexamethasone Suppression Test | ||
| Cortisol (nmol/l) | Patients | Percentage |
| >138 | 13 | 4% |
| 51-138 | 90 | 27.4% |
| <=50 | 226 | 68.7% |
| 1 mg Overnight Dexamethasone Suppression Test | ||
| Cortisol (nmol/l) | Patients | Percentage |
| >138 | 13 | 4% |
| 51-138 | 90 | 27.4% |
| <=50 | 226 | 68.7% |
| Pathway Outcomes | ||
| Discharged | 268 | 81.5% |
| Medical clinic | 40 | 12.2% |
| Surgical clinic | 12 | 3.6% |
| Deceased | 5 | 1.5% |
| Declined | 3 | 0.9% |
| Relocated | 1 | 0.3% |
| Pathway Outcomes | ||
| Discharged | 268 | 81.5% |
| Medical clinic | 40 | 12.2% |
| Surgical clinic | 12 | 3.6% |
| Deceased | 5 | 1.5% |
| Declined | 3 | 0.9% |
| Relocated | 1 | 0.3% |
| Surgical Outcomes * | ||
| Phaeochromocytoma /Paraganglioma | 8 | 40% |
| Adrenal cancer | 3 | 15% |
| Adenoma | 3 | 15% |
| Metastasis | 2 | 10% |
| Cushing’s | 2 | 10% |
| Conns | 1 | 5% |
| Ectopic ACTH bilateral adrenalectomy | 1 | 5% |
| *Includes patients who were not classified as incidentaloma at detection | ||
| Surgical Outcomes * | ||
| Phaeochromocytoma /Paraganglioma | 8 | 40% |
| Adrenal cancer | 3 | 15% |
| Adenoma | 3 | 15% |
| Metastasis | 2 | 10% |
| Cushing’s | 2 | 10% |
| Conns | 1 | 5% |
| Ectopic ACTH bilateral adrenalectomy | 1 | 5% |
| *Includes patients who were not classified as incidentaloma at detection | ||
Discussion: The widespread use of cross-sectional imaging has led to an increasing number of adrenal incidentaloma referrals to endocrinology. We have assessed 329 patients with this pathway in the last four years and continue to receive an average of 10 referrals per month. Our pathway simplifies the logistics of organizing multiple tests and reduces the number of medical appointments required, leading to quicker appointments. This pathway helps to streamline the patient journey and reduce the cost of medical appointments.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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