Endocrine Abstracts

Background: With the rising number of imaging investigations, incidental discovery of adrenal adenomas is becoming increasingly common. Strict adherence to the European Society of Endocrinology (ESE) guidelines for investigating these lesions poses logistical challenges, particularly in already overburdened endocrine clinics.

Objective: We developed a two-step strategy to address this issue. This abstract presents step one: a retrospective review of current practice to understand the nature and management of adrenal incidentalomas. The second step—implementation of a one-stop, nurse-led clinic supported by a multidisciplinary team (MDT)—is ongoing.

Methods and Results: We audited 150 patients over two years. Most lesions (86%) were unilateral; 80% were benign and non-functioning. Malignancy was identified in four patients, and 15 had functioning adenomas, out of these 14% measured < 2 cms. 5 underwent surgery and 6 patients died. ESE guidelines were generally followed; however, inconsistencies were noted in the evaluation of bilateral lesions. The number of clinic appointments varied widely (1–20), highlighting a lack of uniformity in clinical practice.

Conclusion: Our findings align with ESE, confirming that the majority of adrenal incidentalomas are benign and non-functioning. While adherence to guidelines was largely observed, variability in follow-up and appointment frequency revealed inefficiencies. In response, we have standardized care by educating healthcare professionals and launching a one-stop, nurse-led clinic followed by MDT review. A follow-up audit is planned to assess improvements in clinic capacity and cost-effectiveness.

Reference: 1. European Society of Endocrinology Guidelines on Adrenal Incidentalomas. Eur J Endocrinol. 2023;189(1):G1–G42. [DOI: 10.1093/ejendo/lvad066]