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Adrenal Incidentaloma: Prevalence and Referral Patterns From Routine Practice in a Large UK University Teaching Hospital

Hanna, Fahmy W F; Hancock, Sarah; George, Cherian; Clark, Alexander; Sim, Julius; Issa, Basil G; Powner, Gillian; Waldron, Julian; Duff, Christopher J; Lea, Simon C; Golash, Anurag; Sathiavageeswaran, Mahesh; Heald, Adrian H; Fryer, Anthony A

Adrenal Incidentaloma: Prevalence and Referral Patterns From Routine Practice in a Large UK University Teaching Hospital Thumbnail


Fahmy W F Hanna

Sarah Hancock

Cherian George

Alexander Clark

Basil G Issa

Gillian Powner

Julian Waldron

Christopher J Duff

Simon C Lea

Anurag Golash

Mahesh Sathiavageeswaran

Adrian H Heald


Context: Adrenal incidentalomas (AIs) are increasingly being identified during unrelated imaging. Unlike AI clinical management, data on referral patterns in routine practice are lacking. Objective: This work aimed to identify factors associated with AI referral. Methods: We linked data from imaging reports and outpatient bookings from a large UK teaching hospital. We examined (i) AI prevalence and (ii) pattern of referral to endocrinology, stratified by age, imaging modality, scan anatomical site, requesting clinical specialty, and temporal trends. Using key radiology phrases to identify scans reporting potential AI, we identified 4097 individuals from 479 945 scan reports (2015-2019). Main outcome measures included prevalence of AI and referral rates. Results: Overall, AI lesions were identified in 1.2% of scans. They were more prevalent in abdomen computed tomography and magnetic resonance imaging scans (3.0% and 0.6%, respectively). Scans performed increased 7.7% year-on-year from 2015 to 2019, with a more pronounced increase in the number with AI lesions (14.7% per year).Only 394 of 4097 patients (9.6%) had a documented endocrinology referral code within 90 days, with medical (11.8%) more likely to refer than surgical (7.2%) specialties (P < .001). Despite prevalence increasing with age, older patients were less likely to be referred (P < .001). Conclusion: While overall AI prevalence appeared low, scan numbers are large and rising; the number with identified AI are increasing still further. The poor AI referral rates, even in centers such as ours where dedicated AI multidisciplinary team meetings and digital management systems are used, highlights the need for new streamlined, clinically effective systems and processes to appropriately manage the AI workload.

Journal Article Type Article
Acceptance Date Nov 22, 2021
Online Publication Date Dec 16, 2021
Publication Date 2022
Publicly Available Date May 30, 2023
Journal Journal of the Endocrine Society
Print ISSN 2472-1972
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 6
Issue 1
Keywords adrenal incidentaloma, prevalence, referral pattern, radiology, computerized tomography, magnetic resonance imaging
Publisher URL


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