Endocrine Abstracts

An adrenal incidentaloma (AI) is an adrenal mass ≥1 cm detected on imaging not performed for suspected adrenal disease. Our audit aims to formulate a safe protocol to reduce unnecessary testing, streamline appointments and minimise costs. Data was generated from our local Soliton radiology system. Search criteria included adult CT and MRI with adrenal adenoma (AA) between 2018-2023. 140 incidentalomas were identified and 123 were AA. Full data was obtained on 63 of the cases. Outcomes included size, radiological characteristics and biochemical testing for the functionality of the incidentaloma. In patients who had surgery, histology was also documented. 80% of adenomas were >1.5 cm and 86% were non-functional. 78% of functional adenomas were patients >65y/o. Further imaging was requested in only 21 patients after MDT discussion. 74% were discharged with stable adenomas, only 1% had follow-up appointments. Most AI’s are adenomas and the majority are not functional.

Proposed guideline: • All AI’s should first be discussed in MDT with radiologists to reduce re-imaging.

• If AA <1.5 cm, with no concerning radiological features and age >30y/o, arrange functional work-up. If non-functional, no radiological follow-up and discharge.

• If AA >1.5 cm and age <30y/o, discuss in Endocrine MDT.

• MDT should consider surgery or specific treatment for incidentalomas causing hormone excess or >4 cm size.

• If cortisol <138nmol/l, monitor for comorbidities or discuss surgery.

• If cortisol >138nmol/l with comorbidities or hypertension, hypokalaemia with high aldosterone/ renin ratio and a unilateral adenoma or metanephrine secreting tumours, offer surgery.

• If patient is not for surgery, undertake annual follow-up for 2-4y. If no changes or improves, discharge to GP to monitor annually for hypertension and diabetes. Alert for new concerns.

This approach will streamline referrals for AA, reduce unnecessary imaging, decreases the likelihood of missing sinister pathology and makes a comprehensive management plan. This will save the Trust costs.