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Adherence to guidelines for hormonal evaluation in patients with incidentally detected adrenal nodules: effects of radiology report wording and standardized reporting

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare the rates of hormonal evaluation in patients who had CT reports describing adrenal incidentalomas with and without a specific recommendation for hormonal evaluation.

Materials and methods

We performed a retrospective review of adult outpatients without a history of cancer who had a CT report describing an incidental adrenal nodule. Radiology reports were reviewed to determine whether a standardized macro was used which gave specific recommendations for hormonal evaluation and endocrinology consultation. If no macro was used it was determined whether the report had a recommendation for hormonal evaluation and endocrinology consultation.

Results

A standardized macro recommending hormonal evaluation and endocrinology referral was used in 45/129 (34.8%) reports that described an incidental adrenal nodule. A recommendation for hormonal evaluation was made in 5/84 (6.0%) reports without a macro. Hormonal evaluation was performed in 24/50 (48.0%) patients whose reports recommended it and in 11/79 (13.9%) patients whose reports did not (p < 0.0001). A recommendation for endocrinology referral was made in 2/84 (2.4%) reports without a macro. Patients were seen by endocrinology in 12/47 (25.5%) patients whose reports recommended an endocrinology referral evaluation and 5/82 (6.1%) patients whose reports did not (p < 0.0001). Hormonal evaluation was performed in 17/17 (100%) patients who were seen by endocrinology and 18/112 (16.1%) patients who were not (p < 0.0001). Eleven patients (8.5%) had an evaluation suggesting hyperfunctioning nodules (4 cortisol producing, 6 aldosterone producing, and 1 pheochromocytoma).

Conclusions

Utilizing standardized macros that make specific recommendations for hormonal evaluation in patients with adrenal incidentalomas leads to improved adherence to clinical guidelines.

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Authors and Affiliations

  1. Department of Radiology, University of California, Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Michael T. Corwin, Thomas W. Loehfelm & Ghaneh Fananapazir

  2. School of Medicine, University of California, Davis Medical Center, 4610 X St., Sacramento, CA, 95817, USA

    Aman Arora

  3. Department of Surgery, University of California, Davis Medical Center, 2221 Stockton Blvd., Sacramento, CA, 95817, USA

    Michael J. Campbell

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  1. Michael T. Corwin
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  2. Aman Arora
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  3. Thomas W. Loehfelm
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  5. Michael J. Campbell
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Correspondence to Michael T. Corwin.

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Corwin, M.T., Arora, A., Loehfelm, T.W. et al. Adherence to guidelines for hormonal evaluation in patients with incidentally detected adrenal nodules: effects of radiology report wording and standardized reporting. Abdom Radiol 45, 2910–2915 (2020). https://doi.org/10.1007/s00261-020-02517-3

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  • DOI: https://doi.org/10.1007/s00261-020-02517-3

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