EVALUATION OF ADRENAL ADENOMAS & INCIDENTALOMAS IN A UNIVERSITY BASED ENDOCRINE PRACTICE: A RETROSPECTIVE REVIEW
AACE ePoster Library. Buddhdev K. 05/13/15; 97750; 103
Dr. Kajalben Buddhdev
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Abstract
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Objective: With increasing use of imaging modalities, more incidental adrenal masses are being
discovered. Professional societies including AACE recommend that those adenomas deserve baseline
biochemical work-up; and if found to be benign and nonfunctioning, will need follow-up imaging and
laboratory testing. To our knowledge, it is not known what proportion of these adenomas are getting
appropriate baseline and follow-up work-up. Our study was designed to look at patients with adrenal
adenomas, managed at a University based endocrine practice and study their characteristics and
management strategies.
Methods: We retrospectively looked at the medical records of patients managed between 2009 and
2013. Using ICD 9 diagnostic codes of 227.0, 255.8 and 239.7, we identified 101 patients. On careful
review, 80 patients were found to have adrenal adenomas and included in the study. Data was collected
including demographic information, imaging, laboratory testing, management and follow-up.
Results: Of the 80 patients studied, 60 (75%) were females. The mean age was 61 years. CT scan was
used as initial imaging in 75 (94%). Biochemical testing was performed in 58 (73%), which included
cortisol axis in 48 (83%), mineralocorticoid axis in 45 (78%) and catecholamines in 46 (79%). Follow up
imaging was done in 70 (88%), at an average interval of 36 months. Follow-up biochemical testing was
done in 28 of 58 (48%) at an average interval of 25 months. These were, cortisol axis in 19 (68%),
mineralocorticoid axis in 22 (79%) and catecholamines in 17 (61%). Of the 35 patients who had complete
baseline and follow-up data, 25 were found to be nonfunctioning (71%) and 10 (29%) functioning (3
cortisol, 5 aldosterone, 1 catecholamine secreting and 1 combined cortisol/aldosterone). Of the 25
nonfunctioning ones, 24 (96%) were observed and 1 (4%) had adrenalectomy. Of the 10 patients with
functioning adenomas, 6 were managed with medications (5 aldosterone secreting; 1 combined
aldosterone and cortisol secreting), 1 had surgery (catecholamine secreting) and 3 were observed.
Discussion: The AACE incidentaloma guidelines, recommend that all incidentalomas have to undergo
biochemical evaluation. If they are benign and non-functioning, it is recommended to do follow-up
imaging in 3-6 months as well as biochemical testing annually. Our study is showing that not all patients
are getting the recommended management plan, and when they do the time interval is much longer
than is recommended.
Conclusion: Our single center retrospective review of patients with adrenal adenomas & incidentalomas
revealed that a significant proportion of them may not be getting appropriate testing and follow-up as
recommended by major professional societies.
discovered. Professional societies including AACE recommend that those adenomas deserve baseline
biochemical work-up; and if found to be benign and nonfunctioning, will need follow-up imaging and
laboratory testing. To our knowledge, it is not known what proportion of these adenomas are getting
appropriate baseline and follow-up work-up. Our study was designed to look at patients with adrenal
adenomas, managed at a University based endocrine practice and study their characteristics and
management strategies.
Methods: We retrospectively looked at the medical records of patients managed between 2009 and
2013. Using ICD 9 diagnostic codes of 227.0, 255.8 and 239.7, we identified 101 patients. On careful
review, 80 patients were found to have adrenal adenomas and included in the study. Data was collected
including demographic information, imaging, laboratory testing, management and follow-up.
Results: Of the 80 patients studied, 60 (75%) were females. The mean age was 61 years. CT scan was
used as initial imaging in 75 (94%). Biochemical testing was performed in 58 (73%), which included
cortisol axis in 48 (83%), mineralocorticoid axis in 45 (78%) and catecholamines in 46 (79%). Follow up
imaging was done in 70 (88%), at an average interval of 36 months. Follow-up biochemical testing was
done in 28 of 58 (48%) at an average interval of 25 months. These were, cortisol axis in 19 (68%),
mineralocorticoid axis in 22 (79%) and catecholamines in 17 (61%). Of the 35 patients who had complete
baseline and follow-up data, 25 were found to be nonfunctioning (71%) and 10 (29%) functioning (3
cortisol, 5 aldosterone, 1 catecholamine secreting and 1 combined cortisol/aldosterone). Of the 25
nonfunctioning ones, 24 (96%) were observed and 1 (4%) had adrenalectomy. Of the 10 patients with
functioning adenomas, 6 were managed with medications (5 aldosterone secreting; 1 combined
aldosterone and cortisol secreting), 1 had surgery (catecholamine secreting) and 3 were observed.
Discussion: The AACE incidentaloma guidelines, recommend that all incidentalomas have to undergo
biochemical evaluation. If they are benign and non-functioning, it is recommended to do follow-up
imaging in 3-6 months as well as biochemical testing annually. Our study is showing that not all patients
are getting the recommended management plan, and when they do the time interval is much longer
than is recommended.
Conclusion: Our single center retrospective review of patients with adrenal adenomas & incidentalomas
revealed that a significant proportion of them may not be getting appropriate testing and follow-up as
recommended by major professional societies.
Objective: With increasing use of imaging modalities, more incidental adrenal masses are being
discovered. Professional societies including AACE recommend that those adenomas deserve baseline
biochemical work-up; and if found to be benign and nonfunctioning, will need follow-up imaging and
laboratory testing. To our knowledge, it is not known what proportion of these adenomas are getting
appropriate baseline and follow-up work-up. Our study was designed to look at patients with adrenal
adenomas, managed at a University based endocrine practice and study their characteristics and
management strategies.
Methods: We retrospectively looked at the medical records of patients managed between 2009 and
2013. Using ICD 9 diagnostic codes of 227.0, 255.8 and 239.7, we identified 101 patients. On careful
review, 80 patients were found to have adrenal adenomas and included in the study. Data was collected
including demographic information, imaging, laboratory testing, management and follow-up.
Results: Of the 80 patients studied, 60 (75%) were females. The mean age was 61 years. CT scan was
used as initial imaging in 75 (94%). Biochemical testing was performed in 58 (73%), which included
cortisol axis in 48 (83%), mineralocorticoid axis in 45 (78%) and catecholamines in 46 (79%). Follow up
imaging was done in 70 (88%), at an average interval of 36 months. Follow-up biochemical testing was
done in 28 of 58 (48%) at an average interval of 25 months. These were, cortisol axis in 19 (68%),
mineralocorticoid axis in 22 (79%) and catecholamines in 17 (61%). Of the 35 patients who had complete
baseline and follow-up data, 25 were found to be nonfunctioning (71%) and 10 (29%) functioning (3
cortisol, 5 aldosterone, 1 catecholamine secreting and 1 combined cortisol/aldosterone). Of the 25
nonfunctioning ones, 24 (96%) were observed and 1 (4%) had adrenalectomy. Of the 10 patients with
functioning adenomas, 6 were managed with medications (5 aldosterone secreting; 1 combined
aldosterone and cortisol secreting), 1 had surgery (catecholamine secreting) and 3 were observed.
Discussion: The AACE incidentaloma guidelines, recommend that all incidentalomas have to undergo
biochemical evaluation. If they are benign and non-functioning, it is recommended to do follow-up
imaging in 3-6 months as well as biochemical testing annually. Our study is showing that not all patients
are getting the recommended management plan, and when they do the time interval is much longer
than is recommended.
Conclusion: Our single center retrospective review of patients with adrenal adenomas & incidentalomas
revealed that a significant proportion of them may not be getting appropriate testing and follow-up as
recommended by major professional societies.
discovered. Professional societies including AACE recommend that those adenomas deserve baseline
biochemical work-up; and if found to be benign and nonfunctioning, will need follow-up imaging and
laboratory testing. To our knowledge, it is not known what proportion of these adenomas are getting
appropriate baseline and follow-up work-up. Our study was designed to look at patients with adrenal
adenomas, managed at a University based endocrine practice and study their characteristics and
management strategies.
Methods: We retrospectively looked at the medical records of patients managed between 2009 and
2013. Using ICD 9 diagnostic codes of 227.0, 255.8 and 239.7, we identified 101 patients. On careful
review, 80 patients were found to have adrenal adenomas and included in the study. Data was collected
including demographic information, imaging, laboratory testing, management and follow-up.
Results: Of the 80 patients studied, 60 (75%) were females. The mean age was 61 years. CT scan was
used as initial imaging in 75 (94%). Biochemical testing was performed in 58 (73%), which included
cortisol axis in 48 (83%), mineralocorticoid axis in 45 (78%) and catecholamines in 46 (79%). Follow up
imaging was done in 70 (88%), at an average interval of 36 months. Follow-up biochemical testing was
done in 28 of 58 (48%) at an average interval of 25 months. These were, cortisol axis in 19 (68%),
mineralocorticoid axis in 22 (79%) and catecholamines in 17 (61%). Of the 35 patients who had complete
baseline and follow-up data, 25 were found to be nonfunctioning (71%) and 10 (29%) functioning (3
cortisol, 5 aldosterone, 1 catecholamine secreting and 1 combined cortisol/aldosterone). Of the 25
nonfunctioning ones, 24 (96%) were observed and 1 (4%) had adrenalectomy. Of the 10 patients with
functioning adenomas, 6 were managed with medications (5 aldosterone secreting; 1 combined
aldosterone and cortisol secreting), 1 had surgery (catecholamine secreting) and 3 were observed.
Discussion: The AACE incidentaloma guidelines, recommend that all incidentalomas have to undergo
biochemical evaluation. If they are benign and non-functioning, it is recommended to do follow-up
imaging in 3-6 months as well as biochemical testing annually. Our study is showing that not all patients
are getting the recommended management plan, and when they do the time interval is much longer
than is recommended.
Conclusion: Our single center retrospective review of patients with adrenal adenomas & incidentalomas
revealed that a significant proportion of them may not be getting appropriate testing and follow-up as
recommended by major professional societies.
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