What are the current guidelines for referring a patient with confirmed adrenocortical carcinoma to a specialist for surgical management?

Referral of a patient with confirmed adrenocortical carcinoma (ACC) for surgical management should be made urgently to a specialist multidisciplinary team with expertise in adrenal malignancies. This is because ACC is a rare and aggressive tumour requiring complex surgical intervention by experienced endocrine surgeons to optimise outcomes.

Patients diagnosed with ACC should be referred to centres with specialist expertise in adrenal surgery and oncology, where a multidisciplinary team (MDT) can assess the extent of disease and plan radical surgical resection, which remains the mainstay of curative treatment.

Preoperative assessment should include detailed imaging to define tumour size, local invasion, and metastatic spread, typically with CT or MRI scans, to guide surgical planning. Referral should be prompt once diagnosis is confirmed to avoid delays in potentially curative surgery.

Given the complexity and rarity of ACC, surgery should be performed by surgeons with specific expertise in adrenal gland tumours, ideally within high-volume centres that participate in networks such as the European Network for the Study of Adrenal Tumours (ENSAT).

Perioperative management may also require endocrinology input for hormone excess or insufficiency related to the tumour or adrenal function.

In summary, the current UK clinical approach aligns with European expert consensus recommending urgent referral of confirmed ACC cases to specialist centres with multidisciplinary expertise for surgical management by experienced endocrine surgeons (Gaujoux et al., 2017) ¹.