Endocrine Abstracts

Background: Adrenal incidentalomas (AIs) refer to adrenal masses discovered on imaging performed for conditions unrelated to suspected adrenal diseases. In an ageing population with improving radiological modalities, the detection of AIs has increased. While most are benign, non-functioning adenomas, some may represent functioning and/or malignant disease including adrenal carcinoma. Investigating AIs can be time-consuming and anxiety-inducing for patients, while under-investigation can result in missing life-threatening diagnoses. Thus, AI investigation pathways should be streamlined to achieve both efficiency and cost-effectiveness.

Method: A review of management of AIs was conducted in a large, tertiary centre within the United Kingdom. The size and laterality of lesions including attenuation, functional status and multidisciplinary team (MDT) meeting outcomes were assessed. This is an ongoing audit and the full data analysis will be available at the time of presentation.

Results: A total of 182 patients with AIs were referred between 2019 and 2022. 91 patients were seen in 2021, the data for which is presented below.

Discussion: Under current hospital guidelines, (based on the European Society of Endocrinology’s 2016 recommendations), all patients with AIs undergo biochemical testing and clinical assessment followed by discussion at the adrenal MDT meeting. Similar to published evidence, our data demonstrates that the majority of AIs are benign and non-functioning (84%). Thus, the investigation pathway should be remodelled to avoid unnecessary clinic appointments. For those with benign, non-functional adenomas, a nurse-led or virtual consultation could be offered. Face-to-face appointments for further examination and treatment should be reserved for those with functioning and/or malignant lesions. Given the low risk of malignancy or functional lesions amongst AIs and the expected rise in incidence of reported AIs, it’s imperative to optimise current practice and avoid further strain on clinical services.