Adrenal incidentalomas: are they being worked up appropriately?

Pooja Sahni; Apoorva Trivedi; Abdulkadir Omer; Nitin Trivedi

doi:10.3402/jchimp.v6.32913

Adrenal incidentalomas: are they being worked up appropriately?

J Community Hosp Intern Med Perspect. 2016 Oct 26;6(5):32913. doi: 10.3402/jchimp.v6.32913. eCollection 2016.

Authors

Pooja Sahni¹, Apoorva Trivedi², Abdulkadir Omer³, Nitin Trivedi⁴

Affiliations

¹ Division of Hematology and Oncology, Stony Brook University School of Medicine, Stony Brook, NY, USA.
² Apoorva Trivedi is a Third Year Medical Student, University of Vermont Medical School, Burlington, VT, USA.
³ Division of Endocrinology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.
⁴ Division of Endocrinology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA; trivedinitin1@gmail.com.

Abstract

Introduction: Adrenal incidentalomas are defined as masses picked up on imaging studies that were done for apparently different reasons. With frequent use of imaging modalities, incidental adrenal masses are commonly encountered in clinical practice. Guidelines are currently available for the diagnosis and management of adrenal incidentalomas, but the appropriateness of initial work-up and subsequent follow-up of incidental adrenal masses in the community hospital setting is unknown.

Objective: We studied the appropriateness of initial work-up and follow-up of incidental adrenal masses discovered on abdominal computerized tomography (CT).

Methods: In our retrospective study, we reviewed sequential CT scans of the abdomen performed in the month of January 2010 at a community hospital. Once patients with one or more adrenal masses were identified, outpatient charts for initial biochemical testing and follow-up imaging were obtained either through directly accessing the electronic medical records or through contacting primary care physician's offices. Patient charts were reviewed to assess the data for the next 2 years following the discovery of an adrenal abnormality.

Results: Twenty adrenal masses were incidentally discovered on 723 abdominal CTs performed within the month of January 2010 resulting in an overall incidence of 2.76%. Of the patients with incidentally discovered adrenal masses, appropriate biochemical and follow-up imaging were only performed in patients referred to an endocrinologist (2 of 20 patients). Thirty percent of patients with incidental masses received a repeat CT scan for non-adrenal reasons, and no change in the mass size was noted.

Conclusion: Despite published guidelines, the initial work-up and follow-up of patients with an incidentally discovered adrenal mass is unsatisfactory. There is a desperate need for education of providers regarding appropriate work-up of incidental adrenal masses.

Keywords: Adrenal incidentaloma; abdominal CT scan; adrenal mass; adrenal metastasis; adrenal nodule; adrenal tumor; incidental mass.