Outcomes and opportunities: evaluating an unselected cohort of patients with adrenal incidentaloma at a tertiary hospital in New Zealand.

BACKGROUND: The prevalence of adrenal incidentalomas is increasing, along with the incidence of functional or malignant lesions. This study assessed how imaging of adrenal incidentalomas at a tertiary hospital in Auckland, New Zealand, without a dedicated adrenal incidentaloma service, conformed to the American College of Radiology (ACR) recommendations for radiological screening, as well as how using a non-washout imaging approach affected clinical and service outcomes. Secondary outcomes included determining how biochemical screening conformed to the European Society of Endocrinology (ESE) guidelines and patient-related factors influencing completion of ACR screening.

METHODS: A retrospective audit of adrenal incidentalomas was performed using a local healthcare database RESULTS: Data from 10 278 consecutive patients with computed tomography scans were evaluated. The overall prevalence of incidentalomas was 1.4%, and 143 lesions were detected. Of these, 65/143 (45.5%) followed the ACR imaging guidelines, and 21/143 (14.7%) followed the ESE guidelines. Older adults were 2.9 times less likely to complete ACR and ESE follow-up compared to younger adults, while people with lesions >4 cm versus ≤4 cm were more likely to complete ACR follow-up. Only 11 patients were referred to endocrinology, and this subgroup had a significantly higher rate of ACR adherent evaluation (81.8% vs 12.1%, P = 0.0002). Using a non-washout method of radiological follow-up resulted in 80 fewer scans.

CONCLUSION: Most patients with adrenal incidentalomas did not receive guideline-recommended imaging or biochemical follow-up. The establishment of integrated adrenal incidentaloma clinics and the use of non-washout follow-up scans may improve both clinical outcomes and patient experience.