D.D. Muñoz Wilson1, C. Frye1, J.D. Osborne2, H. Negrete1, A. Gillis1, J. Fazendin1, H. Chen1, B. Lindeman1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2University Of Alabama at Birmingham, General Internal Medicine, Birmingham, Alabama, USA
Introduction:
Approximately 5% of all cross-sectional imaging studies will detect adrenal masses ordered for non-adrenal indications, known as adrenal gland incidentalomas (AGIs). Almost one quarter of AGIs will be biochemically active or harbor malignancy, though prior studies have shown low rates of guideline-adherent biochemical and imaging evaluation. The aim of this project is to describe the rates of surgical and endocrinology referral from a dedicated AGI clinic at an academic medical center in the Southeast.
Methods:
A natural language processing (NLP) algorithm was used to search all radiology reports for cross-sectional images that captured the adrenal gland from August 2021 – July 2024. Accepted patients were invited for further evaluation in a dedicated AGI clinic. Demographic, laboratory, radiologic, and other clinical data were collected from the medical record and stored in a secure, web-based registry and summarized with descriptive statistics.
Results:
A total of 804 were seen in the dedicated AGI clinic from February 2022 – July 2024. Of these, 6% (n=46) were referred to an endocrinologist while 10% (n=79) were referred to an endocrine surgeon. The remaining 84% (n=679) of patients were followed in the AGI clinic with serial labs and imaging or discharged from clinic.
Of the patients referred to endocrinology, the reasons for referral include confirmation of hyperaldosteronism, 67% (n=31), hypercortisolism 13% (n=6), a combination of hyperaldosteronism and mild autonomous cortisol secretion (MACS) 13% (n=6), non-suppressed ACTH 4% (n=2), and elevated DHEA-S 2% (n=1). An additional 4% (n=2) were subsequently referred to endocrine surgeons Notably, 22% (n=10) of those referred to endocrine clinic either no showed or cancelled their appointment, were lost to follow up, or indicated they desired no further follow up.
Of patients referred directly to endocrine surgery from the AGI clinic, 50% (n=40) were sent for MACS, 16% (n=13) for hyperaldosteronism, 9% (n=8) a combination of hormonal imbalances, 8% (n=6) due to size >4 cm, 3% (n=2) for overt Cushing syndrome, and 3% (n=2) for pheochromocytoma. A substantial proportion (41%, n=33) of these patients underwent adrenalectomy.
Conclusion:
Implementation of a dedicated AGI clinic has led to 10% and 6% referral rates to endocrine surgery and endocrinology, respectively, with the rest receiving guideline-adherent management through the AGI clinic. A large proportion referred to endocrine surgery underwent adrenalectomy.