Cargando…
SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty
Whilst the estimated prevalence of adrenal incidentaloma is 0.5-2% following abdominal CT scan (1), little is known about subsequent endocrine referral patterns according to clinical specialty. We therefore examined the range of specialties that were responsible for requesting CT and MRI scans that...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7208814/ http://dx.doi.org/10.1210/jendso/bvaa046.1040 |
_version_ | 1783530934330458112 |
---|---|
author | Hanna, Fahmy W F Hancock, Sarah George, Cherian Issa, Basil George Lea, Simon Powner, Gillian Waldron, Julian Golash, Anurag Fryer, Anthony |
author_facet | Hanna, Fahmy W F Hancock, Sarah George, Cherian Issa, Basil George Lea, Simon Powner, Gillian Waldron, Julian Golash, Anurag Fryer, Anthony |
author_sort | Hanna, Fahmy W F |
collection | PubMed |
description | Whilst the estimated prevalence of adrenal incidentaloma is 0.5-2% following abdominal CT scan (1), little is known about subsequent endocrine referral patterns according to clinical specialty. We therefore examined the range of specialties that were responsible for requesting CT and MRI scans that led to reporting potential adrenal lesions. We also explored the referral pattern to endocrinology following identification. We extracted data from all radiology reports for all CT and MRI scans from Jan 2018-Oct 2019. We utilised a key phrase search strategy (eg adrenal adenoma/lesion/mass/nodule/incidentaloma, incidental adrenal, indeterminate adrenal). Where possible we excluded false hits (eg no adrenal lesion). These were lined to the referral patterns as identified by a referral logged or an attendance (new or follow-up) to endocrine clinic 3 months post index scan. These data were stratified by requesting specialty. Preliminary data showed that, out of 127878 scans, 2021 patients were identified to have a potential adrenal incidentaloma. These requests came from a total of 45 different clinical specialities (medical and surgical). The top 12 specialties accounted from 82.8% of these referrals. Medical specialties (renal, gastroenterology, respiratory, general medicine, acute medicine and geriatric medicine) accounted for 50.2%. The remaining 32.6% were via surgical specialities. The overall referral pattern in these cases was 8.5% with no difference between medical (8.6%) and surgical (8.4%) specialties. In conclusion, adrenal incidentalomas are potentially identifiable across a wide range of specialties. Currently, despite a dedicated adrenal multidisciplinary team and nationally-acknowledged quality improvement programme for the management of adrenal incidentalomas (2), the majority of cases are overlooked and not referred for endocrine review as suggested in current guidelines. We expect the findings in our centre to be reproducible elsewhere. We are considering innovative approaches to improve the process and cope with the additional workload cost-effectively. 1. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149:273-285. Hanna FWF, Issa BG, Lea SC, George C, Golash A, Firn M, Ogunmekan S, Maddock E, Sim J, Xydopoulos G, Fordham R, Fryer AA. Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness. BMJ Open Quality. 2019;In press. |
format | Online Article Text |
id | pubmed-7208814 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-72088142020-05-13 SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty Hanna, Fahmy W F Hancock, Sarah George, Cherian Issa, Basil George Lea, Simon Powner, Gillian Waldron, Julian Golash, Anurag Fryer, Anthony J Endocr Soc Adrenal Whilst the estimated prevalence of adrenal incidentaloma is 0.5-2% following abdominal CT scan (1), little is known about subsequent endocrine referral patterns according to clinical specialty. We therefore examined the range of specialties that were responsible for requesting CT and MRI scans that led to reporting potential adrenal lesions. We also explored the referral pattern to endocrinology following identification. We extracted data from all radiology reports for all CT and MRI scans from Jan 2018-Oct 2019. We utilised a key phrase search strategy (eg adrenal adenoma/lesion/mass/nodule/incidentaloma, incidental adrenal, indeterminate adrenal). Where possible we excluded false hits (eg no adrenal lesion). These were lined to the referral patterns as identified by a referral logged or an attendance (new or follow-up) to endocrine clinic 3 months post index scan. These data were stratified by requesting specialty. Preliminary data showed that, out of 127878 scans, 2021 patients were identified to have a potential adrenal incidentaloma. These requests came from a total of 45 different clinical specialities (medical and surgical). The top 12 specialties accounted from 82.8% of these referrals. Medical specialties (renal, gastroenterology, respiratory, general medicine, acute medicine and geriatric medicine) accounted for 50.2%. The remaining 32.6% were via surgical specialities. The overall referral pattern in these cases was 8.5% with no difference between medical (8.6%) and surgical (8.4%) specialties. In conclusion, adrenal incidentalomas are potentially identifiable across a wide range of specialties. Currently, despite a dedicated adrenal multidisciplinary team and nationally-acknowledged quality improvement programme for the management of adrenal incidentalomas (2), the majority of cases are overlooked and not referred for endocrine review as suggested in current guidelines. We expect the findings in our centre to be reproducible elsewhere. We are considering innovative approaches to improve the process and cope with the additional workload cost-effectively. 1. Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149:273-285. Hanna FWF, Issa BG, Lea SC, George C, Golash A, Firn M, Ogunmekan S, Maddock E, Sim J, Xydopoulos G, Fordham R, Fryer AA. Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness. BMJ Open Quality. 2019;In press. Oxford University Press 2020-05-08 /pmc/articles/PMC7208814/ http://dx.doi.org/10.1210/jendso/bvaa046.1040 Text en © Endocrine Society 2020. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Adrenal Hanna, Fahmy W F Hancock, Sarah George, Cherian Issa, Basil George Lea, Simon Powner, Gillian Waldron, Julian Golash, Anurag Fryer, Anthony SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty |
title | SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty |
title_full | SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty |
title_fullStr | SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty |
title_full_unstemmed | SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty |
title_short | SAT-161 Adrenal Incidentalomas: Pattern of Referral According to Clinical Specialty |
title_sort | sat-161 adrenal incidentalomas: pattern of referral according to clinical specialty |
topic | Adrenal |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7208814/ http://dx.doi.org/10.1210/jendso/bvaa046.1040 |
work_keys_str_mv | AT hannafahmywf sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT hancocksarah sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT georgecherian sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT issabasilgeorge sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT leasimon sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT pownergillian sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT waldronjulian sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT golashanurag sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty AT fryeranthony sat161adrenalincidentalomaspatternofreferralaccordingtoclinicalspecialty |