Article Text

other Versions

PDF
Adrenal incidentalomas: management in British district general hospitals
  1. Emily Davenport1,
  2. Pitsien Lang Ping Nam2,
  3. Michael Wilson3,
  4. Alastair Reid4,
  5. Sebastian Aspinall5
  1. 1Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
  2. 2Department of Accident and Emergency, Wansbeck General Hospital, Northumbria Healthcare NHS Trust, Newcastle, UK
  3. 3Department of General Surgery, Perth Royal Infirmary, Tayside University Hospital NHS Trust, Perth, UK
  4. 4Department of General Surgery, Northumbria Healthcare NHS Trust, North Tyneside, UK
  5. 5Endocrine and General Surgeon, Department of General Surgery, North Tyneside Hospital, Northumbria Healthcare NHS Trust, Northumberland, UK
  1. Correspondence to Dr E Davenport, Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Queen Victoria Rd, Newcastle upon Tyne, Tyne and Wear NE1 4LP, UK; emily{at}med.co.nz

Abstract

Introduction Adrenal incidentalomas have become a common clinical dilemma with the increasing use and resolution of cross sectional imaging modalities.

Objectives This retrospective observational study examined the management of adrenal incidentalomas in district general hospitals in Northumbria and adherence to current guidelines.

Materials and methods We searched 4028 abdominal CT scans performed in Northumbria between 1 January and 31 December 2010. All patients with an incidental adrenal lesion were identified and their clinical records reviewed.

Results 75 patients with adrenal incidentalomas were identified. Of these, only 13 (17%) were referred for specialist review with a further two patients undergoing additional evaluation by the primary medical team; 80% received no biochemical investigation or follow-up. Comorbidity may have affected the decision in a proportion, but 36 of 62 patients (58%) had no comorbidities precluding additional evaluation. In contrast, all patients reviewed by an endocrine specialist were appropriately investigated and managed, the majority conservatively, with three requiring adrenalectomy for phaeochromocytoma or cortisol secreting adenomas. In the patients with an incidentaloma, comorbidities which may be attributable to autonomous adrenal cortisol or aldosterone release were higher than regional averages, suggesting possible undiagnosed functional tumours.

Conclusions The management of adrenal incidentalomas in British district general hospitals in Northumbria shows poor adherence to guidelines. Adherence was significantly better in those patients managed by an endocrine specialist. We suggest a pathway for the management and referral process.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.