title: Adherence to adrenal incidentaloma guidelines is influenced by radiology report recommendations.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Waikato Hospital, Hamilton, New Zealand.
authors: Binula N
authors: BN
authors: Wickramarachchi
authors: Department of Surgery, Waikato Hospital, Hamilton, New Zealand.|Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
authors: Goswin Y
authors: GY
authors: Meyer-Rochow
authors: Department of Radiology, Waikato Hospital, Hamilton, New Zealand.
authors: Kim
authors: K
authors: McAnulty
authors: Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
authors: John V
authors: JV
authors: Conaglen
authors: Waikato Clinical School, University of Auckland, Hamilton, New Zealand.|Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand.
authors: Marianne S
authors: MS
authors: Elston
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: adrenal cortex neoplasm; adrenal gland neoplasm; adrenalectomy; adrenocortical adenoma; health care; quality assurance