O093 The adrenal incidentaloma clinic: a novel and streamlined approach

Abstract

Abstract Introduction An incidental adrenal nodule is present in 1–3% of abdominal cross-sectional imaging and pose a diagnostic dilemma for the investigating clinician. Adrenal nodules can be functional or pose a cancer risk, hence a complete adrenal hormone profile investigation is necessary. Methods We piloted a streamlined clinic within the endocrine surgery department for assessing adrenal incidentalomas by trained surgical care practitioners. Data was collected retrospectively for patients reviewed from March 2020 to September 2021 to evaluate its efficacy and the completion of investigations. Results 98 new patients were seen, with an average age of 64.97 (±13.91) years. The mean time from referral to review was 37.61 (±26.07) days. The mean nodule size was 21.74 (±9.93) mm (range: 6.00–73.00 mm) and were most commonly identified on CT virtual colonoscopy (28.6%), CT abdomen and pelvis (20.4%) and Trauma CT (10.2%), with over two-thirds of referrals from colorectal services (38.9%) and Emergency Medicine (29.5%). 82.7% of patients had metanephrines tested, 79.6% for aldosterone-renin ratio and 75.5% for overnight dexamethasone suppression test following clinic attendance. 8.6% of patients had raised metanephrines, with 25.6% for aldosterone-renin ratio and 37.8% for overnight dexamethasone suppression test. 27.8% were referred on for further assessment with an adrenal CT. Three patients were operated on, one for phaeochromocytoma and two patients for metastases. Conclusion Preliminary results suggest this clinic provides efficient services with good completion of investigations and follow-up. It offers clinicians unfamiliar with or unable to organise adrenal investigations, a dedicated clinic, to ensure appropriate clinical assessments. Take-home message This dedicated incidentaloma clinic contributes to the effective use of resources in doing hormonal profiling for patients and identification of patients at risk of functional and malignant adrenal disease.