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Updated: Sep 28, 2025
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Missed Opportunities to Promptly Diagnose and Treat Adrenal Tumors
Konstantinos I Makris1, Danielle L Clark2, Alexandra W Buffie2
1Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Baylor College of Medicine, Houston, Texas.
Introduction:
Adrenal mass management guidelines are insufficiently applied, and timeliness of treatment is unknown. We evaluated missed opportunities to promptly diagnose and treat adrenal tumors that ultimately required adrenalectomy.
Methods:
From the Veterans Affairs Corporate Data Warehouse, we identified patients who underwent adrenalectomy (2010-2016) in the South-Central Veterans Affairs HealthCare Network and reviewed their records. Diagnostic timeliness was assessed by the interval between initial (index) imaging with adrenal abnormality and the next diagnostic step. Workup was defined as early (interval ≤6 mo) or late (>6 mo). Adrenalectomy was considered prompt when the interval between index imaging and adrenalectomy was ≤12 mo and delayed when this was >12 mo. We quantified diagnostic and treatment delays and assessed factors associated with delayed adrenalectomy.
Results:
During the study period, 84 patients underwent adrenalectomy: male (86.9%), White (57.1%), with a mean age of 58.7 y (±8.8). Of those, 25 (29.8%) had late workup, and 36 (42.9%) had delayed surgery (median interval: 44 mo, range 14-282). Late hormonal workup occurred in 24 of 36 (66.7%) patients with delayed surgery, compared with one of 48 (2.1%, P < 0.001) with prompt surgery.
Conclusions:
Missed opportunities in prompt diagnosis and treatment were common in patients with adrenal masses ultimately requiring adrenalectomy. Late hormonal workup is associated with delayed adrenalectomy. Interventions are needed to aid clinicians to recognize the presence, promptly evaluate, and make guideline-informed decisions on the management of an adrenal mass.
Insights
Many patients with adrenal masses requiring surgery experience delays in diagnosis and treatment. Late hormonal workup is linked to delayed adrenalectomy, indicating a need for improved clinical management strategies.
Area of Science:
- Endocrinology
- Surgical Oncology
- Health Services Research
Background:
- Adrenal mass management guidelines are not consistently applied.
- Timeliness of diagnosis and treatment for adrenal tumors is often unknown.
Purpose of the Study:
- Evaluate missed opportunities for prompt diagnosis and treatment of adrenal tumors.
- Assess diagnostic and treatment delays in patients undergoing adrenalectomy.
Main Methods:
- Retrospective review of 84 patients who underwent adrenalectomy (2010-2016).
- Assessed diagnostic timeliness by interval between initial imaging and next diagnostic step (workup ≤6 months: early; >6 months: late).
- Defined prompt adrenalectomy as ≤12 months from initial imaging; delayed as >12 months.
Main Results:
- 29.8% of patients had late workup, and 42.9% experienced delayed surgery (median 44 months).
- Late hormonal workup was significantly associated with delayed adrenalectomy (66.7% vs 2.1%, P < 0.001).
Conclusions:
- Missed opportunities for prompt diagnosis and treatment of adrenal masses are common.
- Late hormonal workup correlates with delayed adrenalectomy.
- Interventions are needed to improve clinician recognition, evaluation, and guideline-informed management of adrenal masses.
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