Endocrine Abstracts

Background: Adrenal Incidentalomas (AI) are identified during 4–7% of cross-sectional imaging studies of the abdomen. The European Society of Endocrinology guidelines (ESE, 2023) set out key recommendations for AI assessment, including the use of non-contrast CT to determine if typical features of a lipid-rich adenoma are present. We reviewed our local AI service, with specific evaluation against current ESE AI guidelines.

Methods: All external and internal referrals to CUH over a 6-month period (Aug23 to Jan24) were analysed. In addition to demographic details, initial radiological characterisation and endocrine laboratory assessments were noted, along with the findings of subsequent investigations that were required to enable clinical decision-making. Reasons for referral were compared with ESE guidelines.

Results: Of 155 referrals, 70% were internal and 30% were external referrals (female 56%; male 44%). Dedicated adrenal imaging was available in 65% of cases at the time of referral, in the remainder, additional imaging was recommended to permit characterisation or guide further investigations or intervention. 56% of cases had undergone some form of hormonal evaluation prior to referral, with 31% showing biochemical evidence of autonomous hormone secretion, including 22% showing mild autonomous cortisol secretion. After radiological work up, 54% were deemed benign, 12% indeterminate, 6% suspicious for a primary adrenal malignancy, 3% suspicious for metastases, 4% myelolipomas, 5% adrenal hemorrhages, and 2% as other conditions (e.g., hemangiomas, hyperplastic adrenal glands); 6% of cases remained uncharacterized, and 8% were deemed not to have an AI.

Conclusion: Our findings confirm that referrals to the CUH AI service largely adhere to ESE guidelines. An important observation was that 35% of cases could not be adequately assessed radiologically at the point of referral due to non-dedicated adrenal imaging. To streamline the review, a formal referral proforma has been introduced, which standardizes the collection of clinical, biochemical, and imaging data.