Unveiling the Silent Threat: Disparities in Adrenal Incidentaloma Management

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.