O'Connor John P, Poloju Alekya, Pabich Samantha K, Allen Betty, Sippel Rebecca, Kind Amy, Chiu Alexander
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin, Madison, Wisconsin.
J Surg Res. 2025 Jul;311:143-150. doi: 10.1016/j.jss.2025.04.031. Epub 2025 May 26.
Adrenal incidentalomas are increasingly detected, yet infrequently evaluated for hormonal excess. We investigated if patient neighborhood disadvantage is associated with the rate of workup of adrenal nodules.
We performed a retrospective analysis of chest and abdomen CT scans between January 1, 2021, and January 6, 2022, at a single tertiary care center in adults with an incidentally found adrenal mass. Chart review was conducted to categorize patients' neighborhood disadvantage utilizing the Area Deprivation Index and evaluate for biochemical workup. Multivariate logistic regression was performed to determine factors associated with adrenal mass evaluation. A secondary chart review was conducted to ascertain reasons for incomplete adrenal nodule workup among disadvantaged patients.
Among 245 included patients, most (71%) had no biochemical workup and only 11% received a guideline-concordant full evaluation. Patients living in disadvantaged neighborhoods were less likely to receive biochemical workup compared to patients in advantaged neighborhoods (odds ratio 0.51, 95% confidence interval 0.26-0.98). Additionally, scans ordered by primary care providers were associated with greater evaluation rates compared to emergency medicine providers (odds ratio 4.08, confidence interval 1.69-9.81). We identified three issues potentially contributing to low workup rates: radiologists recommended no further workup, primary care providers did not order additional tests, and patients were lost to follow-up.
The rate of guideline-based biochemical workup of adrenal incidentalomas was low at 11%, and over 70% had no evaluation at all. Patients from disadvantaged neighborhoods were significantly less likely to receive workup, as were patients seen through the emergency department.
肾上腺偶发瘤的检出率日益增加，但针对激素分泌过多的评估却很少进行。我们研究了患者所在社区的不利因素是否与肾上腺结节的检查率相关。
我们对2021年1月1日至2022年1月6日期间在一家三级医疗中心偶然发现肾上腺肿块的成年患者进行了胸部和腹部CT扫描的回顾性分析。通过查阅病历，利用地区剥夺指数对患者所在社区的不利因素进行分类，并评估生化检查情况。进行多因素逻辑回归分析以确定与肾上腺肿块评估相关的因素。进行二次病历查阅以确定弱势患者肾上腺结节检查不完整的原因。
在纳入研究的245名患者中，大多数（71%）未进行生化检查，只有11%接受了符合指南的全面评估。与生活在优势社区的患者相比，生活在弱势社区的患者接受生化检查的可能性较小（优势比0.51，95%置信区间0.26 - 0.98）。此外，与急诊科医生开出的扫描相比，初级保健提供者开出的扫描与更高的评估率相关（优势比4.08，置信区间1.69 - 9.81）。我们确定了三个可能导致检查率低的问题：放射科医生建议不再进一步检查、初级保健提供者未开出额外检查以及患者失访。
肾上腺偶发瘤基于指南的生化检查率较低，为11%，超过70%的患者根本没有接受评估。来自弱势社区的患者接受检查的可能性明显较低，通过急诊科就诊的患者也是如此。
