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Adrenal incidentalomas: are they being worked up appropriately?
Pooja Sahni1, Apoorva Trivedi2, Abdulkadir Omer3
1Division of Hematology and Oncology, Stony Brook University School of Medicine, Stony Brook, NY, USA.
Journal of Community Hospital Internal Medicine Perspectives
|November 3, 2016
Summary
The work-up and follow-up of incidentally discovered adrenal masses in community hospitals are inadequate, highlighting a need for provider education on appropriate diagnostic and management guidelines.
Area of Science:
- Endocrinology
- Radiology
- Health Services Research
Background:
- Adrenal incidentalomas are common findings on imaging studies performed for other reasons.
- Current guidelines exist for diagnosis and management, but their application in community hospitals is unclear.
Purpose of the Study:
- To evaluate the appropriateness of initial work-up and follow-up for incidental adrenal masses found on abdominal CT scans in a community hospital setting.
Main Methods:
- Retrospective review of abdominal CT scans from January 2010.
- Analysis of outpatient charts for biochemical testing and follow-up imaging for patients with adrenal masses over two years.
- Assessment of adherence to established guidelines.
Main Results:
- An incidence of 2.76% for adrenal incidentalomas was observed (20 masses in 723 CTs).
- Appropriate work-up and follow-up occurred in only 10% of cases (2/20 patients), specifically those referred to endocrinology.
- 30% of patients received repeat CT scans for unrelated reasons without changes in mass size.
Conclusions:
- The current management of incidental adrenal masses in community hospitals is suboptimal and does not align with established guidelines.
- There is a critical need to educate healthcare providers on the appropriate diagnostic work-up and follow-up protocols for incidental adrenal masses.
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