Management of Adrenal Incidentalomas: A Survey of Physicians from the Middle East and Africa.

Abstract

INTRODUCTION: Adrenal incidentaloma (AI) is a common finding from increased imaging use. Several guidelines direct evaluation and management, but limited data exist on real-world practices. AIM: To describe the knowledge and practices of physicians from the Middle East and Africa (MEA) in AI. METHODS: An online survey evaluated the definition of AI, diagnostic investigations, management approach, and long-term follow-up of patients with AI. RESULTS: 171 questionnaires were analysed. Adult and pediatric endocrinologists represented 71.4% of participants. A homogenous mass, < 4 cm and < 10HU, was considered benign by 57.9% of the respondents. The threshold of 4 cm for tumor size was considered suggestive of malignity by 64%. A minority, 34 (19.9%), indicated that no further imaging was required if a non-contrast CT scan was consistent with a benign adrenal mass. Most important endocrinopathies would routinely be excluded: hypercortisolism (97.7%), pheochromocytoma (95.3%), and primary hyperaldosteronism (87.1%). In a lesion considered biochemically inactive at the outset, 56.4% of the respondents would have recommended repeated biochemical testing, and 42.8% would have followed up the patients for 4 and 5 years, irrespective of radiological features. CONCLUSIONS: There is an under-appreciation of the risk of malignancy of AI > 4 cm and a tendency of over-investigating patients in whom a benign tumor has been established, with repeated unnecessary biochemical and radiological evaluation, revealing sub-optimal adherence to guidelines regarding AI in this region.