Quality Assessment of Adrenal Incidentaloma Management at NorthShore University HealthSystem

Friday, May 13, 2022

12:10 PM – 12:25 PM

Location: Station 11, Sapphire West Foyer

Submitter(s)

SG
Sriesakthi Gowrisankar
High School Student
Adlai E Stevenson High School
Buffalo Grove, Illinois, United States
AF
Abigail Froyshteter

Co-Author(s)

SG
Sriesakthi Gowrisankar
High School Student
Adlai E Stevenson High School
Buffalo Grove, Illinois, United States
KK
Kristine Kuchta, MS
Statistician
NorthShore University
Evanston, Illinois, United States
TM
Tricia Moo-Young
AK
Amna Khokar, MD
Endocrine Surgery Fellow
NorthShore University
Chicago, Illinois, United States
MV
Mandakini Venkatramani
EM
Erin MacKinney
DW
David Winchester
RP
Richard Prinz, MD, FACS
Professor, Endocrine Surgery
NorthShore University, United States

Objective : Adrenal incidentalomas are nodules found in cross-sectional imaging studies intended for a different purpose. There are guidelines provided by the combined 2009 American Association of Clinical Endocrinology (AACE) and American Association of Endocrine Surgeons (AAES), and the 2020 Endocrine Society for evaluation and management of adrenal incidentalomas. We sought to assess compliance with these guidelines at an academic community hospital.

Methods: Guidelines recommend a complete biochemical evaluation to identify functioning nodules. Non-functioning nodules >4 cm should be resected, while those less than 4 cm require radiographic reevaluation 3-24 months later and annually for 1 to 2 years. Our electronic medical record was queried for patients with adrenal incidentaloma between 1/2017-1/2018. Univariable and multivariable logistic regression analysis was used to identify factors associated with biochemical evaluation.

Results: 1776 patients were identified. Those with a history of malignancy and previously identified adrenal nodules were excluded, leaving 235 patients. Complete biochemical evaluation was minimal for patients of all ages (16.0%), despite radiological identity (adenoma or indeterminate). 2 cm nodules were more likely to get a complete biochemical evaluation vs nodules 1-2 cm (11.5% vs 4.1%, p-value =0.003). Patients 18-50 were more likely to have a complete biochemical evaluation than those between 51-80 and >80 (20.0% vs 5.4% vs 0%, p-value =0.006). All age groups had less than 40.0% recommended repeat imaging and less than 7.0% had repeat imaging. Nodules >2 cm were more likely to have imaging recommendations and 16 month repeat imaging vs 1-2 cm nodules (21.8% vs 6.8% vs p-value =0.007). Adenomas were more likely to have imaging recommendations and 16 month repeat imaging vs indeterminate nodules (16.7% vs 8.2%, p-value =0.039). Only 3 patients had nodules >4 cm and 1 patient had surgery (lap adrenalectomy).

Discussion/Conclusion: Clinicians and radiologists are not following guidelines for adrenal incidentalomas. Clinicians and radiologists should be educated on biochemical evaluation and repeat imaging so patients in need of surgical resection are not missed. Radiographic reports should include imaging and biochemical recommendations for adrenal incidentalomas.