Incidental Adrenal Masses: Adherence to Guidelines and Methods to Improve Initial Follow-Up: A Systematic Review

Feeney, Timothy; Madiedo, Andrea; Knapp, Philip E.; Gupta, Avneesh; McAneny, David; Drake, Frederick Thurston

doi:10.1016/j.jss.2021.07.041

Cited by 6 publications

(4 citation statements)

References 45 publications

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“…5,6 For example, one recent systematic review revealed that only 34% of IAMs receive indicated radiographic follow-up and only 18% receive a biochemical evaluation consistent with published guidelines. 6 Adherence to guidelines may increase detection of clinically meaningful incidentalomas such as early pulmonary cancers or hypersecretory adrenal adenomas. Adherence may also reduce unnecessary testing, lessen patient and provider anxiety, and limit consultations with specialists for benign and/or nonfunctional lesions.…”

Section: Introductionmentioning

confidence: 96%

“…Incidental adrenal masses (IAMs) are identified in 3%–10% of abdominal imaging studies, 1 and incidental lung nodules are detected in 15%–30% of chest computed tomography (CT) scans 2 . Evidence‐based guidelines for incidentaloma management are published by relevant specialty societies (e.g., 2017 Fleischner Criteria and 2016 European Society of Endocrinology IAM Guidelines), 3,4 but the number of patients who undergo guidelines‐adherent evaluations is generally very low 5,6 . For example, one recent systematic review revealed that only 34% of IAMs receive indicated radiographic follow‐up and only 18% receive a biochemical evaluation consistent with published guidelines 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Evidence‐based guidelines for incidentaloma management are published by relevant specialty societies (e.g., 2017 Fleischner Criteria and 2016 European Society of Endocrinology IAM Guidelines), 3,4 but the number of patients who undergo guidelines‐adherent evaluations is generally very low 5,6 . For example, one recent systematic review revealed that only 34% of IAMs receive indicated radiographic follow‐up and only 18% receive a biochemical evaluation consistent with published guidelines 6 . Adherence to guidelines may increase detection of clinically meaningful incidentalomas such as early pulmonary cancers or hypersecretory adrenal adenomas.…”

Section: Introductionmentioning

confidence: 99%

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Point‐of‐care access to clinical guidelines may improve management of incidental findings in the primary care setting

Annesi

Talutis

Goldman

et al. 2023

Evaluation Clinical Practice

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Rationale: Incidental radiographic findings are common, and primary care providers (PCPs) are often charged with the conducting or initiating an appropriate evaluation.Clinical guidelines are available for management of common 'incidentalomas' including lung and adrenal nodules, but guidelines-adherent evaluations are not always performed; for example, in the setting of incidental adrenal masses (IAMs), recent literature suggests that an evidence-based evaluation occurs in <25% of patients for whom it is warranted-a quality and safety concern. Aims and Objectives:The objective of this study was to examine whether point-ofcare access to concise clinical guidelines would promote appropriate evaluations of two common incidentalomas: IAMs and lung nodules.Method: This study was a survey-based, single-blinded, randomized experiment of decision-making within clinical vignettes. Respondents were PCPs in a variety of clinical practice settings, and half were randomly assigned to surveys that included concise clinical guidelines while the other half served as controls without access to guidelines. Scenarios involved patients with IAMs and lung nodules, and the scenarios included both higher-risk and lower-risk lesions. Our primary analysis examined safe versus inappropriate clinical decisions, while a secondary analysis compared guidelines-concordant versus guidelines-discordant responses.Results: For both the higher-risk IAM and higher-risk lung nodule scenarios, safe answer choices were selected at a similar rate by respondents regardless of whether they had access to guidelines or not. However, for the lower risk scenarios, inappropriate answer choices were chosen substantially more frequently by respondents without access to guidelines compared to those with the guidelines (lung: 29.3% vs. 4.5%, p = 0.003, adrenal: 31.6% vs. 7.0%, p = 0.01). There was less variation in the secondary analysis. Conclusion:Survey respondents were significantly more likely to make safe management decisions in lower-risk clinical scenarios when clinical guidelines were available. Point-of-care access to clinical guidelines for incidentalomas is an intervention that may reduce management errors and improve patient safety.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Point‐of‐care access to clinical guidelines may improve management of incidental findings in the primary care setting

Annesi

Talutis

Goldman

et al. 2023

Evaluation Clinical Practice

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“…Notwithstanding these recommendations, a recent systematic review of the literature shows that only a minority of patients undergo biochemical testing (a median of 18% IQR 15–28%) [ 11 ]. This approach-to-the-patient-based-review summarizes current recommendations on the biochemical evaluation and management of functionally active adrenal incidentalomas.…”

Section: Introductionmentioning

confidence: 99%

Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review

Bernardi

Calabrò

Cavallaro

et al. 2022

JCM

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Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3–6%), aldosterone-secreting adenomas (2–3%), as well as malignant nodules, such as adrenocortical carcinomas (2–5%), which can be either functioning or non-functioning. All patients with an adrenal incidentaloma should undergo a few biochemical screening and confirmatory tests to exclude the presence of a functionally active mass. In this approach-to-the-patient-based review, we will summarize current recommendations on biochemical evaluation and management of functionally active adrenal incidentalomas. For this purpose, we will present four case vignettes, whereby we will describe how patients were managed, then we will review and discuss additional considerations tied to the diagnostic approach, and conclude with practical aspects of patient perioperative management. To improve the perioperative management of patients with functional adrenal incidentalomas, multidisciplinary meetings are advocated.

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To report hounsfeld units or not: There is no question

Hamilton,

Green,

Gao

et al. 2024

The American Journal of Surgery

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Incidental Adrenal Masses: Adherence to Guidelines and Methods to Improve Initial Follow-Up: A Systematic Review

Cited by 6 publications

References 45 publications

Point‐of‐care access to clinical guidelines may improve management of incidental findings in the primary care setting

Point‐of‐care access to clinical guidelines may improve management of incidental findings in the primary care setting

Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review

To report hounsfeld units or not: There is no question

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