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Adherence to adrenal incidentaloma guidelines is influenced by radiology report recommendations.
[adrenal incidentaloma]
Approximately
5
%
of
all
abdominal
computed
tomography
(
CT
)
and
magnetic
resonance
imaging
(
MRI
)
scans
reveal
an
adrenal
incidentaloma
.
Although
most
adrenal
incidentalomas
are
benign
non-functioning
adenomas
,
lesions
may
be
hormonally
active
and
/
or
malignant
.
The
aim
of
this
study
was
to
determine
adherence
to
recommended
international
guidelines
and
potential
influencing
factors
when
an
adrenal
incidentaloma
is
identified
in
routine
clinical
practice
.
A
retrospective
study
was
performed
of
all
CT
and
MRI
reports
from
December
2009
to
December
2011
using
a
key
phrase
search
to
identify
patients
with
an
incidental
adrenal
lesion
.
A
total
of
125
patients
with
incidental
adrenal
lesions
were
identified
,
of
which
74
patients
were
considered
appropriate
for
further
endocrine
/
radiological
workup
.
Of
the
74
patients
,
only
19
(
26
%
)
were
initially
referred
to
the
endocrine
service
for
investigation
;
21
/
74
(
28
%
)
had
complete
biochemical
workup
and
24
/
74
(
32
%
)
had
imaging
follow-up
arranged
.
The
reporting
radiologist
provided
advice
for
follow-up
in
31
/
74
(
42
%
)
,
and
action
was
more
likely
to
be
taken
when
this
recommendation
was
given
.
Follow-up
of
the
patients
who
had
not
received
investigation
was
attempted
resulting
in
assessment
of
a
further
23
patients
.
Of
the
44
patients
who
have
undergone
full
assessment
,
four
patients
were
found
to
have
clinically
significant
lesions
(
one
each
of
:
Cushing
's
syndrome
,
phaeochromocytoma
,
Conn
's
syndrome
and
plasmacytoma
)
.
This
study
suggests
that
the
majority
of
adrenal
incidentalomas
may
not
be
investigated
according
to
current
international
guidelines
.
The
recommendations
by
the
reporting
radiologist
appear
to
influence
whether
a
patient
is
referred
for
further
investigation
.
Diseases
Validation
Diseases presenting
"routine clinical practice"
symptom
adrenal incidentaloma
congenital adrenal hyperplasia
cystinuria
scrub typhus
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