Endocrine Abstracts

Plymouth Hospitals NHS Trust (PHNT) has provided a formal adrenal incidentaloma pathway for over 3 years. Clinical outcomes for patients referred to this pathway were reviewed and are presented here. 419 patients have been referred due to incidental adrenal lesion(s) on imaging requested for indications unrelated to the adrenals or cancer. Routine investigation for all patients accepted to the pathway includes biochemical assessment of autonomous cortisol secretion and catecholamine excess. Aldosterone over-secretion is only assessed if clinically indicated. Of 76 patients with aberrant cortisol measurements, 37 underwent repeat/alternative assessment and were subsequently discharged; since Feb’24 patients are no longer offered alternative testing and instead are diagnosed with MACS (8 patients). 13 patients were offered endocrine clinical review, 10 of which were discharged and 3 await appointments. 7 were discharged without further testing or endocrine review. 11 are categorised as miscellaneous. Of 32 patients with elevated metanephrines, 8 underwent repeat/alternative assessment and were subsequently discharged. 10 patients were offered endocrine clinical review, 8 of whom were discharged and 2 await appointments. 4 had adrenalectomy (histologically 3 phaeochromocytomas, 1 mesothelial cyst) and 10 are categorised as miscellaneous. 43 patients were referred to urology, all on the basis of radiologic findings though 22 also had an aberrant metanephrine and/or cortisol finding. 7 underwent adrenalectomy (histologically 3 phaeochromocytomas), 18 remain under surveillance, 16 were discharged. 2 have phaeochromocytomas but are unfit for surgery. In summary, of 419 referred patients 97 (23%) had abnormal initial chemistry (64 (15%) cortisol, 19 (5%) metanephrines, 12 (3%) metanephrines and cortisol, 1 metanephrines and ARR, 1 ARR). 20 patients (5%) required endocrine clinical follow-up. 43 patients (10%) were referred to urology, with 7 patients (2%) undergoing adrenalectomy. 301 patients (72%) required no further investigation or follow-up. No adrenocortical carcinomas have been identified through this service.