Adrenal incidentalomas: management in British district general hospitals
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.
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Over the last 2 decades, there has been a dramatic increase in the detection of AIs; series with contemporary high-resolution CT techniques report a prevalence close to that observed at autopsy.
“Over the last 2 decades, there has been a dramatic increase in the detection of AIs; series with contemporary high-resolution CT techniques report a prevalence close to that observed at autopsy (Table 2 (36-44)).”
From Adrenal incidentaloma (2020) · cites this paper as [36]
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Sherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works
“Over the last 2 decades, there has been a dramatic increase in the detection of AIs; series with contemporary high-resolution CT techniques report a prevalence close to that observed at autopsy (Table 2 (36-44)).”
Background
- Authors
- Davenport, E., Lang Ping Nam, P., Wilson, M., Reid, A., & Aspinall, S.
- Affiliations
- Royal Victoria Infirmary (GB)
- Department of Accident and Emergency, Wansbeck General Hospital, Northumbria Healthcare NHS Trust , Newcastle , UK
- Perth Royal Infirmary (GB)
- Northumbria Healthcare NHS Foundation Trust (GB)
- Corresponding author
- Davenport, Emily
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-03-31
- Volume
- 90
- Issue
- 1065
- Pages
- 365-369
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- OpenAlex
- W2169264535
- Cited by
- 26
- References
- 18
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 3 · 2018: 3 · 2016: 2 · 2015: 1
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medical Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- adrenal incidentaloma, clinical management, guideline adherence, pheochromocytoma, comorbidities, adrenalectomy, district hospitals, management pathway
- MeSH terms
- Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, United Kingdom, Hospitals, District, Humans, Male, Middle Aged, Prognosis, Referral and Consultation, Retrospective Studies, Tomography, X-Ray Computed, Comorbidity, Prevalence, Practice Guidelines as Topic, Guideline Adherence
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