Audit of adrenal biopsies at a large tertiary referral centre: a decade of improving outcomes

Jessica Remfry; Seren Rees; Miriam Asia; Kassiani Skordilis; Alessandro Prete; Ronchi Cristina L; Vasileios Chortis

doi:10.1530/endoabs.117.P83

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Endocrine Abstracts (2026) 117 P83 | DOI: 10.1530/endoabs.117.P83

SFEBES2026 Poster Presentations Endocrine Cancer and Late Effects (12 abstracts)

Audit of adrenal biopsies at a large tertiary referral centre: a decade of improving outcomes

Jessica Remfry ¹ , Seren Rees ¹ , Miriam Asia ² , Kassiani Skordilis ² , Alessandro Prete ^1,2 , Cristina L Ronchi ^1,2 & Vasileios Chortis ^1,2

Author affiliations

¹Institute of Metabolism and Systems Science, University of Birmingham, Birmingham, United Kingdom; ²Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom

Background: Adrenal biopsies are used sparingly in the diagnosis of adrenal tumours and should only be undertaken when stringent criteria are met. A 2014 audit at Queen Elizabeth Hospital Birmingham (QEHB) showed only 17% of biopsies performed over a 10-year period were undertaken in accordance with guideline recommendations. This formed the basis for the implementation of a specific local pathway, including the recommendation that adrenal biopsies should only be undertaken after adrenal Multidisciplinary Team (MDT) review.

Aim: To re-audit indications and outcomes of adrenal biopsies (2015-2024) at QEHB against 2014 standards.

Methods: Electronic databases were searched for entries associated with the term ‘adrenal biopsy’ (01/01/2015 – 30/09/2024). Two independent researchers reviewed each biopsy against criteria: i) exclusion of phaeochromocytoma, ii) prior discussion in adrenal MDT, iii) clinical indication according to ESE-ENSAT guidelines, and iv) biopsy completion within two weeks.

Secondary analyses: • Sensitivity and specificity for diagnosis of malignancy. • Rate of non-diagnostic and abandoned biopsy attempts.

Results: 48 adrenal biopsies were reviewed, of which 15 (31%) met all criteria. Biochemical exclusion of a phaeochromocytoma had been secured in 43 cases (90%, vs 21% in 2014). 46 requests were clinically indicated (96%, vs 47% in 2014), while 37 had been discussed in adrenal MDT. Median wait was 15 days, with 23 (48%) biopsies completed within 2 weeks. The rate of biopsies not resulting in diagnosis was 12.5% (4/6 non-diagnostic, 2/6 insufficient), abandoned attempts 2.1%, complications 0%. Of 30 biopsies assessed for diagnostic performance for malignancy, sensitivity and specificity were 95% (CI: 75.1-99.9%) and 100% (CI: 69.1-100%), respectively. Biopsy results changed management in 29 (60%) cases.

Conclusions: This audit showed improved standards of care for patients undergoing adrenal biopsy QEHB including appropriate use and prior exclusion of catecholamine excess for most patients. Referral to procedure time was highlighted as an area for improvement.