ORIGINAL ARTICLE   

Minerva Endocrinologica 2020 March;45(1):18-28

DOI: 10.23736/S0391-1977.18.02780-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

A clinical audit: diagnostic and epidemiological evaluation of the adrenal incidentaloma

Vincenzo NUZZO ¹ ✉, Tiziana ATTARDO ², Giuseppe AUGELLO ², Davide BRANCATO ³, Clelia CANALE ⁴, Salvatore CAMERLINGO ⁵, Federica CORETTI ¹, Alessandro FRANCO ⁶, Francesco GIACOMETTI ⁵, Maurizio GAMBACORTA ⁷, Massimiliano LORENO ⁸, Ada MAFFETTONE ⁹, Vincenzo PROVENZANO ³, Alfonso ZUCCOLI ¹

¹ Unit of Endocrinology and Human Nutrition, Ospedale del Mare, Naples, Italy; ² Barone Lombardo Hospital, Canicattì, Agrigento, Italy; ³ Partinico Hospital, Palermo, Italy; ⁴ Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy; ⁵ San Gennaro Hospital, Naples, Italy; ⁶ Parodi Delfino Colleferro Hospital, Rome, Italy; ⁷ Media Valle del Tevere Hospital, Todi, Perugia, Italy; ⁸ Avola-Noto Hospital, Siracusa, Italy; ⁹ Monaldi Hospital, Naples, Italy

BACKGROUND: Audit is a clinical instrument of government characterized by a whole process of evaluation inter pares to improve medical behaviors in the clinical practice. Different endocrinopathies are underestimated in the clinical and diagnostics practice but they can be a real problem in patients admitted in the departments of Internal Medicine. The adrenal incidentaloma is an accidental discovery with an incidence equal to 4% in radiologic studies but it’s rarely considereted in the internal disorders. In the departments of Internal Medicine are hospitalized each year approximately 1450,000 patients and 58,000 about them show a surrenalic lesion identified with CT or MRI as Adrenal Incidentaloma.
METHODS: Through a search in the radiological archives, were reviewed all abdominal CT performed in the year 2012 in 8 departments of Internal Medicine of 8 Italian public hospitals. They also examined all medical records of these patients to value clinical management of the adrenal masses and the real incidence of the adrenal incidentaloma.
RESULTS: Distribution of pathological results show an important incidence about adrenal incidentaloma in Italian patients although this pathology is represented as a rare disease and its clinical and economic burden are significant. Many questions remain unanswered as the association between duration and severity of the disease, morbidity and how the dimensions affecting it. These results need to be supported by important studies with long follow-up to realize an easy diagnosis.
CONCLUSIONS: The results of this audit confirm the real incidence of this pathology in the internistic patients and the final target is to implement changes about therapeutic diagnostic pathway of the hospital patients in the internal medicine departments.

KEY WORDS: Adrenal incidentaloma; Clinical audit; Diagnosis, differential