Synopsis
Select endocrine imaging only when it answers a defined anatomical question, and refer urgently when structure or hormone activity threatens vision, neurology or physiology.
- For stable endocrine disease, establish a credible biochemical syndrome before looking for its anatomical source; common incidental lesions otherwise create misleading causality.
- Imaging defines location, extent and complications but rarely proves whether a lesion secretes hormone, so anatomical and functional questions must remain separate.
- A thyroid ultrasound is driven by a palpable nodule, cervical lymphadenopathy, compressive concern or surveillance indication, not by an abnormal TSH alone.
- Pituitary MRI follows supported hormone or mass-effect findings; formal visual-field assessment is urgent when the lesion approaches the optic chiasm or vision changes.
- An adrenal mass needs structured radiological characterisation and hormonal assessment; exclude phaeochromocytoma before biopsy or invasive treatment.
- Functioning, indeterminate, enlarging or suspicious endocrine lesions belong in a specialist multidisciplinary pathway where radiology, biochemistry and operative risk are integrated.
- Imaging reports should state size, phenotype, invasion and relevant comparison, while the referrer supplies the exact endocrine question and prior biochemical results.
- Local referral thresholds and access routes vary across UK services; urgent clinical red flags override routine electronic triage.
Investigation priorities
Define sellar anatomy, optic-chiasm relationship, invasion and a potential source after biochemical or neurological indication.
Management branches
A stable patient has a possible hormone-excess or deficiency syndrome without acute compression.
- Define and confirm the biochemical phenotype using appropriately timed basal or dynamic tests, reviewing medicines and assay limitations.
- Select the gland-specific modality only after the result establishes a localisation question, and include the hormone data in the imaging request.
- Reconcile anatomy with physiology in endocrine review; if they conflict, reconsider testing, ectopic sources or an incidental lesion before intervention.
Key medicines
Hydrocortisone for suspected pituitary apoplexy with adrenal compromiseGive emergency parenteral hydrocortisone promptly according to the Society for Endocrinology and local emergency regimen when haemodynamic instability, altered consciousness or other evidence of acute ACTH deficiency is present.Do not delay treatment for cortisol sampling or MRI. Record timing of any pre-treatment bloods, monitor glucose and electrolytes, and obtain specialist advice for subsequent dosing and taper.