Hormonal Evaluation of Incidental Adrenal Masses: The Exception, Not the Rule
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ORIGINAL SCIENTIFIC REPORT
Hormonal Evaluation of Incidental Adrenal Masses: The Exception, Not the Rule Michael J. Kirsch1 • Kun-Tai Hsu2 • Matthew H. Lee3 • Perry J. Pickhardt3 David H. Kim3 • Rebecca S. Sippel4 • Priya H. Dedhia5
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract 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.
4
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
5
Division of Surgical Oncology, Department of Surgery, Ohio State University Comprehensive Cancer Center and Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH 43210, USA
& Priya H. Dedhia [email protected] 1
Department of Surgery, University of Colorado, Aurora, CO, USA
2
Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital and Lewis Katz School of Medicine, Philadelphia, PA, USA
3
Section of Abdominal Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
123
World J Surg
Introduction An adrenal incidentaloma or incidental adrenal mass (IAM) is an adrenal mass that is discovered during a radiologic imaging examination performed for an unrelated reason or during an autopsy. IAMs have a reported prevalence of between 4.4% and 8.7%, which peaks between the 5th and 7th decades. However, this prevalence is based o
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