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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Adrenal
  • Hormonal
  • Incidentalomas
  • Macro
  • Nodule
  • Report

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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