THU608 Evaluation Of Incidental Adrenal Masses After Initial Radiographic Diagnosis
Authors: Williams Vanessa , Wazzan Noor , Limon Makarem Abu , Abdelkarim Jumana Omar , Jakoby Michael G , Sydney Guy , Gagen Ashley , O'neil Hannah , Tarabichi Ula 
Published: October 2023

Disclosure: V. Williams: None. N. Wazzan: None. M. Abu Limon: None. J.O. Abdelkarim: None. M.G. Jakoby: None. G. Sydney: None. A. Gagen: None. H. O'neil: None. U. Tarabichi: None.

Background. Incidental adrenal masses (IAM’s) are masses of the adrenal glands ≥ 1 cm in diameter discovered during imaging for an indication other than adrenal pathology. Diagnosis of IAM’s has increased with improved resolution of computed tomography (CT), but little is published on how often IAM’s are appropriately evaluated and factors that predict if assessment will occur. This study was conducted to determine the frequency with which IAM’s are evaluated according to American Association of Clinical Endocrinologists (AACE) guidelines when diagnosed on CT scans ordered by providers at the Southern Illinois University (SIU) School of Medicine, an academic medical center in rural Central Illinois. Methods. A retrospective single cohort study was performed. Patients age ≥ 18 years undergoing CT from January 1 - December 31, 2017 were eligible. Potential cases were screened by searching for “adrenal mass,” “adrenal nodule,” “adrenal lesion,” or “adrenal adenoma.” Cases were excluded if the mass had been noted before January 1, 2017, imaging was ordered for an adrenal disorder or cancer staging, or the adrenal mass was &lt; 1 cm in largest diameter. Cases were reviewed to determine if recommended metabolic screening and imaging was conducted. Demographic data, insurance status, reason for imaging, type of CT scan, clinical setting, radiology description of the adrenal mass, selected comorbidities (hypertension, hypokalemia, type 2 diabetes mellitus, obesity, and osteoporosis), and referral to an endocrinologist were included as potential predictors of guideline compliant evaluation. Results. A total of 86 IAM’s were identified among 801 CT scans for a prevalence of 10.7%. Only 10 patients (11.6%) underwent metabolic evaluation, 22 had imaging follow-up (25.6%), and only 6 received both (7.0%). All patients with metabolic evaluation were referred to an endocrinologist (P &lt; 0.001). Patients who underwent evaluation were more likely to have CT scans of the abdomen or abdomen and pelvis (P = 0.004) and be diagnosed with hypertension (P = 0.01). Notably, there was no difference in IAM size (evaluated 2.2 ± 1.1 cm, unevaluated 2.0 ± 1.2), and the descriptors “benign” or “benign adenoma” were included in the radiology reports of 88.9% and 88.1% of evaluated and unevaluated patients, respectively. Imaging follow-up was more likely in patients with an endocrine referral (p=0.03), on public insurance (p=0.02), and who were obese (p=0.02). Conclusion. The rate at patient’s with IAM’s were evaluated in accordance with AACE guidelines in this study was very low and may have been strongly influenced by inclusion of the descriptors “benign” or “benign adenoma” in nearly 90% of radiology reports. Providers at SIU who order CT scans need education and guidance on evaluation of IAM’s for metabolic activity and monitoring for changes in size that could indicate adrenocortical carcinoma.

Presentation: Thursday, June 15, 2023