Session: SUN 281-290-Comparative Effectiveness/Health Outcomes/Quality Improvement/Patient or Provider Education/Endocrine Emergencies
Poster Board SUN-281
A multi-disciplinary adrenal service (MDT) was set up in 2008 in a busy 1000-bedded hospital in United Kingdom to cope with the increasing diagnosis of adrenal incidentaloma (AI). Both inpatients and outpatients were referred through an AI pathway and reviewed with monthly discussion by endocrinologist, radiologist, surgeon and pathologist. We reviewed all new cases referred to our MDT between July 2011 and July 2012.
Methods and Results:
During this period, there were 142 MDT episodes recorded for 77 patients. There were 68 new patients reviewed, 3 from out of area. We have analysed data from the remaining 65 patients. Median age was 64 years (range 32-91years) with equal sex distribution (33 female, 32 male). The AI was predominantly left sided (37 Left, 16 Right, 11 Bilateral and 1 absent on review). The AI size was variable (<1cm diameter = 3 patients, 1-4cm = 51, 4-6cm = 6, >6cm = 2, no size documented= 3). After initial investigations 14 patients underwent surgery, & the remainder were followed up for repeat imaging +/- further endocrine investigations. Due to co morbidities including cancer and frailty, 9 patients were discharged at baseline from follow up from MDT and 4 more were discharged after an initial medical review.
Forty-seven patients were screened for phaeochromocytoma with 24hr urinary metanephrine measurements. 9 of these were positive on initial testing. 16 patients were screened for Conn’s syndrome with serum rennin and aldosterone measurement. 2 of these were positive. 9 patients were screened for Cushing’s syndrome by overnight Dexamethasone suppression testing. 3 were positive. 7 patients underwent 24hr urinary cortisol measurements. None were positive. Histological examination of the 14 surgically removed adrenal glands revealed 4 phaeochromocytomas, 3 adreno-cortical adenoma, 2 adreno-cortical hyperplasia, 2 benign cysts, 1 non-functioning adenoma, 1 lymphangioma and 1 unknown (a probable malignancy removed in separate specialty centre)
The development of an AI management pathway and MDT has allowed us to identify and effectively manage a range of hormone secreting adrenal adenomas, initially discovered incidentally. The frequency of identification of hormone hypersecretion- 9/65 (14%) highlights the importance of establishing robust systems to identify and proactively manage the adrenal incidentaloma.
Nothing to Disclose: RMM, RH, LJM, DM
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