Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

Abstract

IntroductionAdrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients.MethodsWe developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability.ResultsImplementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs.ConclusionsThe system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases.

Adrenal İnsidenteloma Olgularında Hemogram Parametrelerinin Değerlendirilmesi ve Klinik Önemi

“…Its prevalence diff ers in distinct risk populations and generally varies between 0.4-10%. [1][2][3] Th e tumors are located bilaterally in 10-15% of cases with adrenal incidentaloma. [4][5] Most of the cases are benign and only 0.7-5% are malignant.…”

The national Targeted Lung Health Checks programme: Focusing on the lungs does not mean missing adrenal lesions

“…To address this gap, we have recently developed a cost-effectiveness tool for adrenal incidentaloma management. 8 We have initiated discussions with the lung cancer screening programme to support their efforts in establishing a clinicallyand cost-effective strategy to address adrenal incidentalomas. Such initiatives are essential if the NHS is to address this potential clinical risk.…”

Adrenocortical Carcinoma: A Case of Missed Diagnosis

“…Adrenal incidentaloma (AI) is a common endocrine condition, and it is defined as an adrenal mass of greater than 1 cm in diameter detected incidentally when performing radiological studies to evaluate a non-adrenal condition or disease. A multidisciplinary workup with a careful laboratory and radiological analysis is required to make a correct diagnosis of the condition and ensure its effective management [ 1 , 2 ]. While AIs are non-functional and benign in most cases, they can be malignant or secreting in approximately 20% of cases [ 1 - 3 ].…”

“…Studies have shown an increase in the prevalence of AIs with advancing age, with peak incidences occurring between the fifth and seventh decades of life [ 1 ]. They are rarely found in patients younger than 30 years of age, and hence such cases, if encountered, should be investigated promptly due to the potential risk of ACC or functional lesions [ 1 , 2 ].…”

“…ACC is a rare and aggressive malignant tumor, and it is associated with two different peaks of incidence: before the age of five and between 40-60 years of age; however, it can also occur in people of any age [ 2 ]. Most cases of ACC are sporadic but can be associated with other tumor syndromes, such as multiple endocrine neoplasia type 1 (MEN1) gene, Beckwith-Wiedemann syndrome (abnormalities in 11p15I gene), and Li-Fraumeni syndrome (TP53 gene) [ 1 - 3 ].…”