12508 Hormonal Evaluation Of Adrenal Nodules After Implementation Of Standardized Radiology Text
Authors: Strunets Alexander , Zhang Catherine , Segal Eric , Wang Tracy S , Dream Sophie , Tolat Parag P , Nencka Andrew S , Findling James W , Brian Carroll Ty 
Published: October 2024

Disclosure: A. Strunets: None. C. Zhang: None. E. Segal: None. T.S. Wang: None. S. Dream: None. P.P. Tolat: None. A.S. Nencka: None. J.W. Findling: Advisory Board Member; Self; Corcept Therapeutics, Diurnal, Recordati. T.B. Carroll: Consulting Fee; Self; Corcept Therapeutics.

Background: Adrenal nodules are commonly found on imaging scans, but many patients with adrenal nodules do not undergo appropriate guideline-directed hormonal evaluation. Interventions to improve hormonal screening are needed. In 9/2020, our institution implemented standardized radiology text for adrenal nodules with recommendations for hormonal evaluation and/or specialist referral in the “Impressions” section of the radiology report. Aim: To 1) assess the rate of hormonal evaluation in patients with adrenal nodules before and after implementation of standardized radiology text and 2) assess factors associated with 1-mg dexamethasone suppression test (DST) screening. Methods: In this retrospective study, we utilized natural language processing to identify two cohorts of patients diagnosed with adrenal nodules on CT imaging report: 1) patients diagnosed in a six month period prior to standardized text implementation (2/2020 to 8/2020) (Pre-IC) and 2) patients diagnosed in a six month period starting one year past the implementation date (8/2021 to 2/2022) (Post-IC) to allow for adoption of the radiology text. We excluded patients who had previously identified adrenal nodule, non-incidental mode of discovery, and no clinic visit within one year of adrenal nodule diagnosis. Rates of hormonal evaluation were compared between the two cohorts. Predictors of DST was assessed using logistic regression analysis. Results: The Pre-IC included 63 patients, and the Post-IC included 139 patients. Rates of hormonal evaluation with 1-mg DST (15% vs 10%, P=0.28), plasma or urinary metanephrines (21% vs 16%, P=0.47), and paired aldosterone/renin (22% vs 13%, P=0.11) trended higher in the Post-IC compared to the Pre-IC but did not reach significance for any single test. Among the Post-IC, the standardized text for adrenal nodules was included in 63% of radiology reports. When comparing Post-IC patients whose radiology reports contained the standardized text to those who did not, rates of paired aldosterone/renin (28% vs 12%, P=0.02) and plasma or urinary metanephrines (26% vs 10%, P=0.02) were higher, but DST rate did not differ (17% vs 12%, P=0.40). On logistic regression analysis adjusted for age, sex, and race, endocrinology visit (OR 16.4, 95% CI 6.2, 42.6) was associated with increased DST. Nodule size, imaging scan location, and use of standardized radiology text was not predictive of DST. Conclusion: Rates of hormonal evaluation for adrenal nodules were low with no difference in any single screening test in the year after standardized radiology text implementation, possibly due to incomplete adoption of the text into practice. Reports that contained the text in the Post-IC were associated with higher rates of screening for primary aldosteronism and pheochromocytoma but not hypercortisolism. Of the factors assessed, an endocrinology visit was the only predictor of increased DST screening.

Presentation: 6/3/2024