Adrenal Tumour Diagnostic Pathway: Results of a National Survey in the United Kingdom

Background: Currently, there is very limited information on referral patterns, diagnostic work-up, and management of adrenal tumours across secondary and tertiary endocrine centres in the UK.

Objective: To evaluate current practices in assessing and managing adrenal tumours across the UK, including diagnostic pathways and adherence to international guidelines on screening of patients with newly diagnosed adrenal tumours.

Methods: A 12-item web-based survey was distributed to members of the UK Society for Endocrinology (approximately 1,600 contacts), capturing centre characteristics, number of patients with adrenal tumours and diagnostic strategies.

Results: Eighty-five responses representing 80 centres were analysed. Over 45% of respondents, mainly from tertiary centres, reported more than 100 annual referrals. Malignancy rates were <5% in 89.5% of centres. Nearly all centres (99.8%) reported full or partial adherence to 2023 ESE–ENSAT guidelines. However, only 55% held regular adrenal-specific multidisciplinary meetings, and 24% reported referral-to-diagnosis times exceeding six months. Steroid profiling (urinary or serum) was incorporated into diagnostic work-up by 71.8% of centres.

Conclusions: This survey provides the first national overview of adrenal tumour management pathways in the UK. Findings highlight strong guideline adherence but variability in multidisciplinary practice and diagnostic timelines. These data offer a foundation for policy development and future research, particularly as increasing incidental detections from cross-sectional imaging place growing demands on NHS resources.