Increasing sensitivity of radiological imaging has led to an increase in the finding of incidental of adrenal masses. Prevalence of these ‘incidentalomas’ vary upon modality of detection and patient cohort. Several organisation guidelines exist in the suggested evaluation of these lesions. We aim to evaluate the incidence and investigation of incidentalomes discovered at our organisation over a two-year period and compare this to established standards.
This retrospective audit identified patients aged over 18 years-old using key word search criteria within radiology reports from CT studies from 2019 and 2020 undergoing CT Chest, CT Chest/Abdomen/Pelvis and CT Renal/CT KUB. Search terms included adrenal adenoma, incidental adrenal lesion, incidentaloma, myelolipoma, adrenal lesion, and adrenal mass. In addition, data the electronic medical record and medical records were interrogated to gather data on follow-up and co-morbidities. Patients with known history of active malignancy, suspected adrenal pathology or previous identified adrenal adenoma were excluded.
A total of 38 881 CT studies were performed during the 2-year period of interest. 1464 studies were identified using key search criteria. When removing duplicates, false positive results, and applying exclusion criteria a total 274 studies were included in the final analyses. Incidence of incidentaloma 0.7 % with median age 70 years old (Range 29-97) and 48.5 % male. 18.1% of patients were referred for biochemical evaluation and 25.9% referred to specialist physician, surgeon, or general practitioner. Final diagnoses were made in 28 patients including non-functional adenoma (24), subclinical Cushing’s syndrome (3), and primary aldosteronism (1).
Our audit demonstrated a need for further education in evaluation and follow-up of incidental adrenal masses with 82% cases not evaluated with biochemistry and 75% not referred for follow-up. Several cases missed screening who had clinical factors that would have warranted biochemistry for primary aldosteronism, a known condition under recognised.