Adrenal tumour diagnostic pathway: findings from a national survey in the United Kingdom.

Background: Currently, there is very limited information on referral patterns, diagnostic workup, and management of adrenal tumours (ATs) across secondary and tertiary endocrine centres in the UK. Objective: To evaluate current practices in assessing and managing ATs across the UK, including diagnostic pathways and adherence to international guidelines on screening of patients with newly diagnosed ATs. Methods: A 12-item web-based survey was distributed to members of the Society for Endocrinology, UK (approximately 1,600 contacts), capturing centre characteristics, number of patients with ATs, and diagnostic strategies. Results: In total, 85 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 6 months. Steroid profiling (urinary or serum) was incorporated into diagnostic workup by 71.8% of centres. Conclusions: This survey provides the first national overview of AT 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.