Hormonal Evaluation of Incidental Adrenal Masses: The Exception, Not the Rule. World J Surg 2020 Nov;44(11):3778-3785
Date
07/12/2020Pubmed ID
32651604DOI
10.1007/s00268-020-05679-9Scopus ID
2-s2.0-85087706495 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
BACKGROUND: Incidental adrenal masses (IAMs) occur in approximately 4% of patients undergoing abdominal CT scans for any indication. Hormonal evaluation is recommended for all IAMs. The purpose of this study was to identify the rate of IAMs in a screening population and to determine the adequacy of endocrine evaluation of newly identified IAMs based on established guidelines.
METHODS: This was a retrospective analysis of 6913 patients undergoing a non-contrast screening CT colonography at a single academic medical center between June 2004 and July 2012.
RESULTS: The prevalence of IAMs in this asymptomatic screening population was 2.1% (n = 148). Of those patients, 8.8% (n = 11) underwent some form of hormonal evaluation and only 6.4% (n = 8) patients had a "complete" workup. Cortisol, metanephrines, and an aldosterone-renin ratio were evaluated in 8.0%, 7.2%, and 4.0% of patients, respectively. Of the patients (n = 11) who underwent hormonal evaluation, 27.3% had functional masses and 36.4% underwent surgery. Of those who did not have hormonal evaluation, 42.1% (n = 48) had comorbidities that should have prompted hormonal evaluation based on established guidelines. Hormonal evaluation was not performed in 89.4% of patients with hypertension and 21.1% of patients with diabetes. 88.9% of patients on three or more antihypertensive medications did not undergo any hormonal evaluation.
CONCLUSIONS: Compliance with IAM workup guidelines is poor, which may result in missed diagnosis of functional adrenal masses. Establishment of a robust protocol and education on appropriate workup for IAMs is necessary for adequate hormonal evaluation.
Author List
Kirsch MJ, Hsu KT, Lee MH, Pickhardt PJ, Kim DH, Sippel RS, Dedhia PHAuthor
Kun-Tai Hsu MD Assistant Professor in the Plastic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Adrenal Gland NeoplasmsAged
Aged, 80 and over
Aldosterone
Colonography, Computed Tomographic
Female
Humans
Hydrocortisone
Incidental Findings
Male
Middle Aged
Prevalence
Retrospective Studies