Adrenal Gland Pathology Reporting Among Genitourinary Pathologists: An Orphan Field Handled by Foster Pathologists?

Due to their association with the kidney, adrenal glands are frequently resected by urologists and evaluated by genitourinary (GU) pathologists. However, given the growing complexity of adrenal pathology and advent of a dedicated "endocrine pathology" subspecialty, herein we sought to assess the sentiment regarding adrenal pathology among GU pathologists. One hundred twenty-eight pathologists who handle GU specimens participated in a survey including both junior (40% < 10 years in practice) and experienced pathologists (60% > 11 years in practice), who work in academic (75%) or private practice settings (25%). Participants reported "on the job" adrenal pathology training (61%) and/or formal training during GU fellowship (36%). While participants felt mainly "comfortable" (36%) or "neutral" (29%) reporting adrenal specimens, some felt "uncomfortable" (15%) or "very uncomfortable" (5%). Most reported that adrenal specimens are handled by GU pathology (56%) versus general surgical pathology (26%) or endocrine pathology (22%; although only 30% reported having formal endocrine pathologists). However, when the participants were asked who they felt should be handling adrenal specimens, participants most strongly endorsed either endocrine pathology (74%) or GU pathology (58%). For workplaces that didn't have a dedicated endocrine pathologist, the main limitations were insufficient number of endocrine pathology specimens for the position (53%; 81% reporting an average of ≤10 per month) or insufficient number of qualified endocrine pathologists (46%). Although adrenal specimens are typically received from urology colleagues, many GU pathologists feel it may be prudent to consider them under the rubric of endocrine pathology services as they become more readily available.