Upload 2 files

Unveiling the Silent Threat_ Disparities in Adrenal Incidentaloma Management.pdf_semantic.json

@@ -0,0 +1,1822 @@
+[
+  {
+    "text": "Unveiling the Silent Threat: Disparities in Adrenal Incidentaloma Management John P.",
+    "tokenCount": 20,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "f00d55bbdc4d002e1dd8ad311703854f465d1fe77585c57463d7e0a77e67d1bf"
+  },
+  {
+    "text": "OConnor, BS, a , * Alekya Poloju, MD, b Samantha K.",
+    "tokenCount": 21,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "a9591869e5873355c693c6b6210c2d3256635004878fa2b8df35de555c118c63"
+  },
+  {
+    "text": "Pabich, MD, b Betty Allen, MD, c Rebecca Sippel, MD, c Amy Kind, MD, PhD, d , e and Alexander Chiu, MD, MPH c a University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin b Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin, Madison, Wisconsin c Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin d Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin e Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin article info Article history: Received 3 January 2025 Received in revised form 31 March 2025 Accepted 19 April 2025 Available online 26 May 2025 Keywords: Adrenal incidentaloma Adrenal nodule Endocrine surgery Health disparities Health equity Incidental adrenal mass Population health abstract Introduction: Adrenal incidentalomas are increasingly detected, yet infrequently evaluated for hormonal excess.",
+    "tokenCount": 209,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "b49660c09bed71b2cf75f8628827f0cde1a9276c67c4eba9acc389a15e21ec07"
+  },
+  {
+    "text": "We investigated if patient neighborhood disadvantage is associated with the rate of workup of adrenal nodules.",
+    "tokenCount": 20,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "03b3f318107c57968e582ae269669d30f3718b5fd836046c0d97878aa627b9b5"
+  },
+  {
+    "text": "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.",
+    "tokenCount": 44,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "8c565db44e3e32bd1df4448640108b8dc0db131cefcdfb1ea6c67429d3d0405b"
+  },
+  {
+    "text": "Chart review was conducted to categorize patients neighborhood disadvantage utilizing the Area Deprivation Index and evaluate for biochemical workup.",
+    "tokenCount": 24,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "bbc3df15c1aa14e3788c1f778cd4366e2a8c9358fb475299a67d74f66b4625cb"
+  },
+  {
+    "text": "Multivariate logistic regression was performed to determine factors associated with adrenal mass evaluation.",
+    "tokenCount": 17,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "0fce76c942438b9c80a66017a35cde8899813aaa0f286cfdf30b3f7b82e21e52"
+  },
+  {
+    "text": "A secondary chart review was conducted to ascertain reasons for incomplete adrenal nodule workup among disadvantaged patients.",
+    "tokenCount": 21,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "70551cce437791468239e3c9d56efcefa6179a605ee3e02c41f9af948e8eb3f5"
+  },
+  {
+    "text": "Results: Among 245 included patients, most (71%) had no biochemical workup and only 11% received a guidelineconcordant full evaluation.",
+    "tokenCount": 30,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "568e7d6ea797c9ee28d0ed99f46c16cc0f188d1468457a6a6511c19d794d04bb"
+  },
+  {
+    "text": "Patients living in disadvantaged neighborhoods were less likely to receive biochemical workup compared to patients in advantaged neighborhoods (odds ratio 0.",
+    "tokenCount": 27,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "86d7dbaad55360c886895293330547b2a63ecc237b67b0692666dbfc25a44aad"
+  },
+  {
+    "text": "Additionally, scans ordered by primary care providers were associated with greater evaluation rates compared to emergency medicine providers (odds ratio 4.",
+    "tokenCount": 25,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "c17eac74840fad04d1b796f7000f605a2c5e8c89cc647315e7519052f3ae3b92"
+  },
+  {
+    "text": "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 followup.",
+    "tokenCount": 37,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "35a0fb9d3abf08507430a8d5f2a1ee5bc25724533053f89b4f8a1274f0850e9e"
+  },
+  {
+    "text": "Conclusions: The rate of guidelinebased biochemical workup of adrenal incidentalomas was low at 11%, and over 70% had no evaluation at all.",
+    "tokenCount": 31,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "6020a62cd0a46c653e16243fc07a17494e4ddbb0cb625c23c0a94b03979b3231"
+  },
+  {
+    "text": "Patients from disadvantaged neighborhoods were significantly less likely to receive workup, as were patients seen through the emergency department.",
+    "tokenCount": 23,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "74b28220a53d457228f36ccbd51dab3a03378e3c194285dedacef54767699ea4"
+  },
+  {
+    "text": "All rights are reserved, including those for text and data mining, AI training, and similar technologies.",
+    "tokenCount": 20,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "389e86dfc71f736cd364f6043977a5f3fb3f4702656c3f78553bbcce65014cb9"
+  },
+  {
+    "text": "University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/724, Madison, WI 53792.",
+    "tokenCount": 26,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "549bb3eaad634def353ce7a65c05bf7e7e9461798638f539bff9679eb585c5bf"
+  },
+  {
+    "text": "Email address: jpoconnor4@wisc.",
+    "tokenCount": 12,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "3465246eacfcec826e6add7e2faae0ac3871d061ff6f21bc4ad29da436fa4525"
+  },
+  {
+    "text": "com journalofsurgicalresearch  july 2025 (311) 143 e 150 0022-4804/$ e see front matter  2025 Elsevier Inc.",
+    "tokenCount": 32,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "cb1688bdd604c08968ffbf830376b09c3594ec9daf990e64345ab13053ac424c"
+  },
+  {
+    "text": "Introduction The prevalence of adrenal tumors has increased over the last several decades, largely due to advancements in imaging techniques.",
+    "tokenCount": 23,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "9cb641042a19a42f719cd92b99622f04011f800fc065f8b99f6272974a4f99fc"
+  },
+  {
+    "text": "1,2 As a result, the term adrenal incidentaloma was created to describe the abnormal unexpected finding.",
+    "tokenCount": 22,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "ab23428ba0cbe510536177f44200f50bb5506f46c8049a029938e127f9c228e7"
+  },
+  {
+    "text": "3 Currently, an incidental adrenal mass (IAM) is defined as a tumor > 1 cm first discovered when investigating a problem unrelated to the adrenal glands.",
+    "tokenCount": 33,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "789fec963fa73bca012accc7e7c7855326d638902b4e24fb2b92109daaa5fcc0"
+  },
+  {
+    "text": "4 Approximately 2%-8% of relevant imaging scans identify an IAM.",
+    "tokenCount": 15,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "64840d364426e0a58e6c00939967ae8b21589f59a8bd7e4e3cb8ed15e3e68041"
+  },
+  {
+    "text": "1,5 Although the majority of adrenal incidentalomas are benign and nonfunctional, an estimated 20%-30% of IAMs are functional and require further treatment.",
+    "tokenCount": 34,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "4ed41230773a77d4572c14351b942f5cb0964cd53e7ae2c72a2ba64ed6c2e140"
+  },
+  {
+    "text": "6-8 All major endocrine, urologic, and radiologic societies recommend additional studies to determine neoplastic potential of IAMs.",
+    "tokenCount": 30,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "0fd384f6fc30d22e9328b68d1faad79b2abd22f09415fb73fc1b61fdf40e03b9"
+  },
+  {
+    "text": "4,6 , 9 Precontrast and postcontrast crosssectional imaging is imperative to accurately determine lesion size, enhancement, and likelihood of malignancy.",
+    "tokenCount": 33,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "0cc8c8d24e27900faa2495e8edd52f58a3cebe8ae14b4e3e477663c50fdd2fe9"
+  },
+  {
+    "text": "Beyond determining malignant potential, IAMs should also be evaluated for hormonal excess using biochemical testing to rule out a functional tumor (i.",
+    "tokenCount": 28,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5372475b470515cc9a8cd8dcccd8f65f91b9bfe054595193266aee65467a104a"
+  },
+  {
+    "text": ", cortisolsecreting adenomas, pheochromocytomas, and aldosteronomas) d which, if left untreated, can lead to significant morbidity and downstream health consequences.",
+    "tokenCount": 42,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "b1e4bfa7f2ea0c4df668f1eae5b14c3ef1de8ad689edb79ebc88899a442fe952"
+  },
+  {
+    "text": "10,11 Despite consensus guidelines from worldwide societies, rates of IAM workup remain low.",
+    "tokenCount": 19,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5f355df12f48504f0b8b8f05b2dcec7c8f514ff8ee45ea0a4b67de87d5ba47de"
+  },
+  {
+    "text": "4,6 , 9 A 2021 systematic review determined less than onethird of patients undergo necessary followup imaging and roughly onefifth of patients receive recommended biochemical testing.",
+    "tokenCount": 33,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "c100c8b6564ca6e32138c94e03cf432eb4641f1b125e02d0aaec9e9de1c42586"
+  },
+  {
+    "text": "12 While compliance with IAM evaluation is low for all patients, some populations may be more affected than others.",
+    "tokenCount": 22,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "377aed63424d0b6a8a57d8c149e72cd23e560753de9e3be6f742b1b22e3728cf"
+  },
+  {
+    "text": "Previous studies have demonstrated social determinants such as race, socioeconomic status, and insurance coverage can influence rates of followup imaging after other incidental radiologic findings, including in the liver and pancreas.",
+    "tokenCount": 40,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "fbdb22fcd3cc6713cb8c1661979d1b4610f65247f19c37c657e5fd71f281542e"
+  },
+  {
+    "text": "13,14 In this paper, we assess the rates of IAMs in a tertiary care setting and social factors associated with appropriate workup compliance.",
+    "tokenCount": 31,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "d532cde9c90ca6bd2780293da18e1c2c02758c19bb0ba2d27dc5b9590d9853ed"
+  },
+  {
+    "text": "We hypothesize socioeconomic disadvantage at the neighborhood level, as measured by the Area Deprivation Index (ADI), will be associated with lower rates of followup and IAM evaluation.",
+    "tokenCount": 37,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "abf75f11dc3b10d13eabdee94b1f2c86ecdb0ab9a0e2d0ccc8b94f473e701f04"
+  },
+  {
+    "text": "Methods We performed a retrospective analysis of all chest and abdominal CT scans between January 1,2021, and June 1,2022, in adults  18 y at a single tertiary care center.",
+    "tokenCount": 40,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "befaf45d72acc266472225f2baed609dfe74baf99906106a07804523993e5762"
+  },
+  {
+    "text": "Radiology reports were screened for the key phrases Adrenal Nodule, Adrenal Mass, or Adrenal Incidentaloma to obtain scans with IAMs.",
+    "tokenCount": 34,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "d29a8fc9351fc155e6265af17dc052f13ed82f116d99b7e644b2c805d5631bd7"
+  },
+  {
+    "text": "Chart reviews were conducted to confirm the reported nodule and evaluate for followup imaging and biochemical evaluation.",
+    "tokenCount": 20,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "59c44b18c52e9a5e2ad21caf741bf2ed0c67fd496a0d3be506cdd92f538db9de"
+  },
+  {
+    "text": "Tumor size and density on noncontrast study was abstracted when available, as well as the specialty of the ordering provider, categorized as primary care provider (PCP), emergency medicine (EM) provider, or subspecialists (i.",
+    "tokenCount": 50,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "525f2cc6e378313cfdef688302433fcb3f2b33639b5a99b1429b8fcfb921196a"
+  },
+  {
+    "text": ", medical subspecialist, general surgery, and surgical subspecialty).",
+    "tokenCount": 15,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "b6f171efcbae14c0105b7e00509eb39d534b084fe0d9c023b11f398ef5497878"
+  },
+  {
+    "text": "Additionally, patient demographic data were abstracted, including patient age, sex, race, insurance status, and comorbidity via calculation of the Charlson Comorbidity Index (CCI), a 10-y survival predictor based on the presence of common diseases.",
+    "tokenCount": 54,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "ffd6c38aa56550544500dc8ec1f8950832e6e508afc95c8a1258bf57c8563595"
+  },
+  {
+    "text": "15 Charts abstractions were performed by two investigators (A.",
+    "tokenCount": 13,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "255f5d003d2a4a6b80e53c7dcf3a95d3901689c798d41169dbd6b09b97f33b71"
+  },
+  {
+    "text": "), with validity and reliability confirmed after 20 doubly abstracted charts.",
+    "tokenCount": 14,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5584a5c08bfc1c4608e2858a579fb57c8376bd26292a90e27e7387ce4a7b6586"
+  },
+  {
+    "text": "Patients, who on review were seen to have their adrenal nodule previously identified, had a nodule measuring < 1cm, or who were deceased within 2 y of CT scan (shortening their time frame for potential workup), were excluded from analysis.",
+    "tokenCount": 53,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "b2240890b2abd22afa14673f199807a5cb096baf14995fbfa8f71d61e75587fc"
+  },
+  {
+    "text": "The Internal Review Board of the University of Wisconsin e Madison reviewed this study and deemed it exempt from full review.",
+    "tokenCount": 22,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "1a68ec5ac976998de39d6228ab6fe0ac3e9cd8d8d8fab294fb8fb59b111dd00b"
+  },
+  {
+    "text": "For each patient, we also determined their statebased ADI ranking from the ninedigit zip code of their primary address in the electronic health record at the time of the CT scan.",
+    "tokenCount": 38,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "3b4527150d696bfa93bd30a4657e7e3759d19f95ec16cc84d500f60b2dc978d2"
+  },
+  {
+    "text": "ADI is calculated using a methodology including 17 factors such as income, education, employment, and housing quality.",
+    "tokenCount": 22,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "1f10e27ed67ed046db35a8188f2eed4a81c14842e71cc1ca6f174b0c50df18a4"
+  },
+  {
+    "text": "16,17 ADI creates a composite index to measure socioeconomic disadvantage within geographic areas, highlighting how communitylevel variables influence health outcomes.",
+    "tokenCount": 26,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "ffa8c649a544866a6749bf5eec1ecf213ab7e14613789fe6cf2f209845b797e8"
+  },
+  {
+    "text": "The tool was validated using US census block data to rank neighborhood socioeconomic disadvantage.",
+    "tokenCount": 15,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "13c7f5987051299db84a905ca1a819bda282b5d0a1b69af85cff885a517b5039"
+  },
+  {
+    "text": "16 Based on recent studies, patients were categorized as being from disadvantaged (upper 50th percentile) or advantaged (lower 50th percentile) neighborhoods according to their ADI score.",
+    "tokenCount": 36,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "2cadf880ad61bd83a913015c2b1939b5a83efb12d197a0647eaf8ffee4ecd5bf"
+  },
+  {
+    "text": "18,19 Primary analysis examined rates at which patients received subsequent biochemical and radiologic evaluations within 2 y of their index scan.",
+    "tokenCount": 25,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "44625d81c029493ae739f3c17e57285fcd23f1bd0ea6bacd59d25d54b82a05ef"
+  },
+  {
+    "text": "If the nodule was identified on a noncontrast CT, patients were considered to have a full workup if they had a proper biochemical evaluation based on imaging and clinical characteristics.",
+    "tokenCount": 36,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "519dab1c4b16ba6a5a0c69778cdf7e22efb0a7ad387855be4266ecdcbfff9573"
+  },
+  {
+    "text": "For lowdensity lesions ( < 10HU), complete workup was considered cortisol evaluation (24-h urine cortisol, multiple midnight salivary cortisol levels, or lowdose dexamethasone suppression test) and an aldosterone/renin ratio if the patient had a history of hypertension or hypokalemia. For lesions > 10HU, complete biochemical workup included cortisol evaluation, metanephrine evaluation (24 h urine or plasma), and plasma aldosterone:renin ratio if the patient had a history of hypertension or hypokalemia.",
+    "tokenCount": 116,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "c6640e8d2f313a8fe647d07c3ccf175711205a2075acee26a6edbfe81a0725dc"
+  },
+  {
+    "text": "If patients had a nodule identified on a contrast CT, proper evaluation included repeat adrenal protocol CT (pre-, early-, and latecontrast phases) or noncontrast CT, as well as the corresponding biochemical workup described above.",
+    "tokenCount": 48,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "8e9f9a4010efa3d04d5a6b32d183cf008303c506946bdebd56880d874a995063"
+  },
+  {
+    "text": "We considered partial workup as the completion of any, but not all, of these recommended tests.",
+    "tokenCount": 20,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "21ab730831b165e455482edefb74f394626a904e37a54ef9dfcd37d6d850ec19"
+  },
+  {
+    "text": "For certain analyses, partial and full workup were combined as any workup due to low numbers of partial and full workups.",
+    "tokenCount": 26,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "f999157270169591224a84a76130e7305991dcd05704ad94cf794be5048287d2"
+  },
+  {
+    "text": "To better understand the reasons for low workup, we performed an additional secondary chart review of 30 patients from disadvantaged neighborhoods who received no workup.",
+    "tokenCount": 29,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "4e719209ba5f4b1dc01578ad7a6f5ae394f9ef551b856374e776920eba2deed8"
+  },
+  {
+    "text": "Clinical notes from the time of imaging and followup PCP notes were evaluated to better understand if any workup was recommended and why it was not completed.",
+    "tokenCount": 32,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "80c28a6c187a6bae66600b2e4bf398b61c777b560c404d50f08f173e72d8b5f8"
+  },
+  {
+    "text": "To analyze clinical notes, two authors (J.",
+    "tokenCount": 10,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "8a6d154ff4db0e663da8633a34f92c9fa841c193b931103edc0e0629c4d419ca"
+  },
+  {
+    "text": "Using a deductive thematic approach, noncompliance themes were identified and categorized.",
+    "tokenCount": 16,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "8d6e6d5f33b5c532a72d184f821b3ad1ca8d8eedb84ebffa186f1a3451adab17"
+  },
+  {
+    "text": "Upon completion, themes were compared and differences were resolved by A.",
+    "tokenCount": 13,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "2b390973b043c94ccaef1dd5953d10cadaf3b7acebcdfe32a296e945e5e03cf9"
+  },
+  {
+    "text": "categorizing clinical notes using our established themes with the ability to create new classifications if necessary.",
+    "tokenCount": 20,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "ab9dcd524e98295168b85bbfe34c99963ae949aead4a4bc52af3541b1ea7b4e1"
+  },
+  {
+    "text": "Following completion, we again reviewed our results as a team to finalize our results.",
+    "tokenCount": 17,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "432adbb1d25d847982fbd777197c2275f246b84c012ed26a231582c479a2d69e"
+  },
+  {
+    "text": "A bivariate analysis was performed using chisquared and Students ttest analysis.",
+    "tokenCount": 17,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "1ca13e270d4b37694483cc94fcec126eb9537ad57391521e79ed1b8af42bcaee"
+  },
+  {
+    "text": "Multivariate logistic regression was performed to evaluate factors associated with biochemical workup.",
+    "tokenCount": 16,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "4991061698652378f5319b6c3133a9973863003635faa29c39eb3ae078beeb60"
+  },
+  {
+    "text": "Results Study cohort During the study period, 9022 patients had a qualifying CT scan performed and 533 (5.",
+    "tokenCount": 23,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "df518aefebb5c12c328b288c0a84804b1aa292f43f04368b23e7c6b32e811e9f"
+  },
+  {
+    "text": "9%) individuals with IAMs were identified.",
+    "tokenCount": 10,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "256a0f12ae5c5c6c3c4754af220b5fcb9f752122ebd72c79ff97c71ab372f647"
+  },
+  {
+    "text": "0%) of 533 patients were included in our final analysis ( Fig.",
+    "tokenCount": 15,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "ed19d71adbe764ffdbb0755cee51e25060dd41c12221208d66ca6e4264ebe6ff"
+  },
+  {
+    "text": "Demographics Overall, the final patient cohort was 58.",
+    "tokenCount": 11,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "a63941d675aa900ffd0e5faf59dfe5f6e8e2126c012e5c76a35a29b982116c5c"
+  },
+  {
+    "text": "0% over 65 y of age, and 86.",
+    "tokenCount": 11,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "6e1bd559365123a932ea1d924590fc7e8e19f05151afd6693d4faf065ce13b32"
+  },
+  {
+    "text": "6% reporting a CCI of 0 or 1.",
+    "tokenCount": 11,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "43814a9ca3f37bba5160750af84d0576ef8977fe2ed42bd2a962593edb3bd265"
+  },
+  {
+    "text": "The most common ADI deciles were 4 or 5, making up 17.",
+    "tokenCount": 16,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "6f66fad6b6854f0c26e43a699a0c8fd6791059c6a4a743d272be462fab767089"
+  },
+  {
+    "text": "0%) were from advantaged neighborhoods (lower 50th percentile ADI).",
+    "tokenCount": 15,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "05e36ac9ad81283d7d8bc61caa3337fffa6d870ac567215d0919c8547f0fb662"
+  },
+  {
+    "text": "Imaging and ordering provider characteristics The majority of the imaging which discovered the IAM was ordered by EM providers (50.",
+    "tokenCount": 24,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "954611b750e3d4ef3f4be30904fa01173f74cf390a731697d0eced4680b898e6"
+  },
+  {
+    "text": "6%), followed by subspecialists (36.",
+    "tokenCount": 10,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "7a0a06739299a034aedfdb385dcdcbe7ef28676b10e82e61671a0f5fa5e277c5"
+  },
+  {
+    "text": "1% of ordering providers were physicians, while the remainder were physician assistants or nurse practitioners.",
+    "tokenCount": 18,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "19d0d016a9441614720ce9bcc47a623a8f55de405a018ba864fd37d0c92ca01a"
+  },
+  {
+    "text": "The vast majority of the CTs ordered were with contrast (93.",
+    "tokenCount": 14,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "71e781fd0539abbd79618c202e1e6f79b76e9139ae77c0db032abe20541bb2e7"
+  },
+  {
+    "text": "Rate of IAM workup Most (71%) IAM patients received no further workup, 18% had partialevaluation,and11%hadfullassessment( Fig.",
+    "tokenCount": 36,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "0582203935db25c3eb8ca6dd3d340f0aa7bf8a1c263e4426501517e13c901afa"
+  },
+  {
+    "text": "A chisquare test revealed statistically significant associations between sex, neighborhood disadvantage, and ordering provider with IAM workup.",
+    "tokenCount": 25,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "c41b164363b02f4778a53c5641309082c68da7cbf78a1cbb9b1411cede3ffdd5"
+  },
+  {
+    "text": "03) patients had a significantly higher rate of workup, while patients with imaging ordered by EM providers had a significantly lower rate of workup compared to those ordered by primary care (54.",
+    "tokenCount": 38,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "8b985bed16a843239813d95a1e6f7de65545d1031f2e180ba73e47ba0fd343bd"
+  },
+  {
+    "text": "5% from PCPs, P < 0.",
+    "tokenCount": 10,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "5259926197b18652554f0836f01f0553c138920e2b6cd4ed65eff90afc019f0f"
+  },
+  {
+    "text": "8% had scans ordered by EM providers and 17. 8% had scans ordered by PCPs ( Table 2 ).",
+    "tokenCount": 23,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "b446adad7c41046e905ec792aa48fd218c569dfcec3adcbcf532e650666b3da2"
+  },
+  {
+    "text": "Of the disadvantaged patients, scans ordered by EM providers and PCPs were 45.",
+    "tokenCount": 16,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "bc9a038a3fe92b5002cf78de3376bbd34fc790d989849344c69c56e0524ea12d"
+  },
+  {
+    "text": "Comparison of patients who hadapartialorfullworkupispresentedin Supplementary Table 1 .",
+    "tokenCount": 20,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "eb2c5deca1390e080a82a6b9880e90d75f216c1f58b8134f26b4a86446395daa"
+  },
+  {
+    "text": "Factors associated with biochemical evaluation Logistic regression demonstrated disadvantaged patients were less likely to undergo any workup compared to advantaged patients (odds ratio [OR] 0.",
+    "tokenCount": 34,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "02526a4422eccf1efaeca862e824eeaf5c048a334fa333998166b13886509a11"
+  },
+  {
+    "text": "Other factors significantly associated with receiving any workup included female sex (OR 2.",
+    "tokenCount": 16,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "7c74ab440cdfe26a9af66f05ce02d6da3f278f2533f49ac4cc2ad2b98557f2f6"
+  },
+  {
+    "text": "31) and scans ordered by PCPs (OR 4.",
+    "tokenCount": 12,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "4c9737010234f21b6c5ebc9baf515f76d48f6e55577af7dc4fbbb53705b5d074"
+  },
+  {
+    "text": "There was no statistically significant difference in workup based on age, race, ethnicity, insurance status, or CCI.",
+    "tokenCount": 24,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "887fad859fc7bda19043bf6d0d91fa79c4f27571bf4a1f5db5343059ed1d626b"
+  },
+  {
+    "text": "Secondary chart review Examination of physician notes and radiology reports from 30 disadvantaged patients without IAM workup revealed three main themes which may have contributed to the lack of evaluation ( Table 4 ).",
+    "tokenCount": 38,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "fca74128cc4db9d1d46eee113fb19b46972dc165a2d5cd943dc935c85be7b375"
+  },
+  {
+    "text": "The most common theme of missed evaluation related to radiology reports recommending no further workup.",
+    "tokenCount": 18,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "6454ee7945cbfdd8341f4df656be95f7285ab19d341c40b367af7adb10e0dad9"
+  },
+  {
+    "text": "While this was likely meant to signal that the lesion needed no further radiographic workup to evaluate for malignant potential, this was often interpreted as no further workup was needed at all, including biochemical workup.",
+    "tokenCount": 44,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "b0c3ea8ed850b6c400bf55b0f193bb930aefb7d95c484e84bdaed1691c4b1bb7"
+  },
+  {
+    "text": "For instance, a communication from one PCP to a patient with an adrenal nodule noted that the scan demonstrated an adrenal lesion that was benign, and echoed the report that no further evaluation was needed, even though a functional workup was never performed.",
+    "tokenCount": 53,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "2e6dff2a9f7ed88d2878e2091861cba2a99366234648324405f259cbea1973b0"
+  },
+  {
+    "text": "Second most common was PCPs not acknowledging the nodule nor ordering additional tests, suggesting these incidental findings were missed.",
+    "tokenCount": 23,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "1c739631aa23da965b19735fdd23bfe172ad1a32f9c53010b4dbf023aa355df9"
+  },
+  {
+    "text": "patients were frequently lost to followup after imaging and never completed biochemical testing when recommended.",
+    "tokenCount": 18,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "2365a039aa0b07fcf0ede9e4ca4a4f66b296bad0c17ff9d0cb26184ae01091b9"
+  },
+  {
+    "text": "Discussion In our study, the rates of complete guidelineconcordant biochemical workup or partial evaluations of adrenal incidentalomas were 11% and 18%, respectively.",
+    "tokenCount": 33,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "2a65e42beaf429fd51c68699c024442d3d31eaa613ff343be5572ce381206050"
+  },
+  {
+    "text": "These alarmingly low rates align with other publications, confirming absent or incomplete IAM evaluations are commonplace.",
+    "tokenCount": 20,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "f9e75031b7a6989bf8ae30e841a4858ede6f0a92df21685a88ef8351cf2f4cb7"
+  },
+  {
+    "text": "2,12 , 20 For instance, Ebbehoj et al .",
+    "tokenCount": 15,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "b969f17959cafbc08cf63b0a58617d2c85a33cd247b560a4e29f8c14a4424282"
+  },
+  {
+    "text": "(2020) reported appropriate workup of IAMs was completed in only 15.",
+    "tokenCount": 17,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "46942053f5d28300e711896d010ba5404f4d9b05f5b1c838c2c4386120c9a3e4"
+  },
+  {
+    "text": "2 These low rates of workup undoubtedly lead to poor patient outcomes, as untreated hormonally active adrenal incidentalomas have been tied to higher rates of cardiovascular events and even mortality.",
+    "tokenCount": 37,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "c65d2d40db910bfb09b570ead5f37704a497841e815c6323f76fc3457fd507b3"
+  },
+  {
+    "text": "10,11 , 21 Workup rates were particularly low for patients living in disadvantaged neighborhoods.",
+    "tokenCount": 18,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "1d4fd18c85cf085e4b83de8fa675f1bd47265c74bff1b29d3e2167faf5151289"
+  },
+  {
+    "text": "We found patients from these neighborhoods had roughly half the odds of obtaining any IAM workup compared to those from advantaged neighborhoods.",
+    "tokenCount": 26,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "2b70c6b2ab41bc39264ac0d476465fd0338bddcbfd610454631d04c64ca949b1"
+  },
+  {
+    "text": "Our findings are consistent with literature linking neighborhoodlevel disadvantage with poorer health outcomes and disease management.",
+    "tokenCount": 18,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "aea72adba63fa384c9ba769918ba9b4b48a1ec2d4bf8877bb9df1b926304f682"
+  },
+  {
+    "text": "22,23 Similarly, Schut and Mortani Barbosa (2020) reported racial/ethnic disparities in incidental pulmonary nodule management.",
+    "tokenCount": 27,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "e74b5c023eef9fc85da4c4c4b49e0136de55fc6ac2f445a595f13a7c80fa33ce"
+  },
+  {
+    "text": "24 Differences in care of IAMs may have downstream effects, potentially exacerbating preexistent disparities in comorbidities such as diabetes and hypertension.",
+    "tokenCount": 31,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "c3746907a3f444f85b44efe1386ebce518ee087e8d5274c5966615d838db7058"
+  },
+  {
+    "text": "25,26 The relationship is likely multifactorial and involves patient access to PCPs, reliance on safety net programs or emergency departments (EDs), and more fragmented care.",
+    "tokenCount": 35,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "5d7f920163226c00d65aa31f979d3286404a4b9109aee5f18bb3d9e642e8c730"
+  },
+  {
+    "text": "23,27 Furthermore, our secondary chart analysis revealed lack of followup as a common theme among patients in disadvantaged neighborhoods, reinforcing that many of the issues revolve around the ability to access Table 1 e Demographics.",
+    "tokenCount": 43,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "af04aec920841684a8259bc59221e778edab71e5db23762e3673cbebcb3ab816"
+  },
+  {
+    "text": "No workup (n  174) % Any workup (n  71) % Total cohort (n  245) % P value Sex < 0.",
+    "tokenCount": 32,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "a225ba89652354225bf2435338c956b5f8b8fa065a9bd9ad7cf8def811bbe32c"
+  },
+  {
+    "text": "03 Advantaged ( < 50 percentile) 51.",
+    "tokenCount": 11,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "d5d7f80f6ceac4347c666601be6d54ecb4969e9ce64e7c2b836a17f24ac25f62"
+  },
+  {
+    "text": "0 Disadvantaged ( > 50 percentile) 48.",
+    "tokenCount": 11,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "a9a37d281ff7b68089e18eb614561ec89f1a9b50392164223b6c3b7164d08107"
+  },
+  {
+    "text": "Additionally, clinics serving disadvantaged patients typically have limited resources, and as a result, prioritization of other urgent health matters may supersede evaluation of incidentalomas.",
+    "tokenCount": 31,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "47e1cf17b99e997585432ebce7be489291d5a96e10687cc700fae5126c6a1174"
+  },
+  {
+    "text": "28 While our study demonstrated poor IAM workup compliance across all medical/surgical fields, investigations were significantly lower when diagnoses were established during ED visits.",
+    "tokenCount": 31,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "f16b64df717dbf176a6f55c276e4fe4e652f7cf29048bf79b52e5e9260905d9e"
+  },
+  {
+    "text": "(2020) reported a threefold lower rate of followup imaging if the index study was performed while the individual was an inpatient or in the ED compared to outpatient.",
+    "tokenCount": 34,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6ea8e7a5bade0d8c041b7a636fbf3b6e2883c8a368e52f254104a94705cc0879"
+  },
+  {
+    "text": "29 Interestingly, several previous publications focused on poor IAM workup compliance in primary care outpatient settings.",
+    "tokenCount": 20,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "e24bf745604564cd8c173a6bb3060c7d5ad2527fc0040ca659ffe50116d1608f"
+  },
+  {
+    "text": "30,31 The authors suggested PCPs may lack time and/or knowledge of appropriate biochemical evaluations to adequately address IAMs.",
+    "tokenCount": 26,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "3d0634c5ede1f7b1f9a2c83b9ec6db8b37a2b3148db91c3e348218181243c70d"
+  },
+  {
+    "text": "However, our study suggests the emergency room as a potentially larger source of missed IAM management.",
+    "tokenCount": 19,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6c046ff5828c92e806bdfae83790a2ed263a9a54670a1f921d8d9319bc7489fa"
+  },
+  {
+    "text": "Although disadvantaged patients had higher rates of detection by EM providers, ordering provider remained a significant factor even when controlling for socioeconomic deprivation.",
+    "tokenCount": 25,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d93ab61a5a27ee0d09d737d7303f29d6787db5cc1530221172ef639f89a8ae94"
+  },
+  {
+    "text": "Our chart review noted PCPs failing to acknowledge the nodule as a major reason for missed workup, and suggests that communication between EM and PCPs remains a challenge to properly addressing IAMs.",
+    "tokenCount": 40,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d283c238fe9cab18933c35a97cd1ca95aeb52347059aab9fa8c787835e1c1645"
+  },
+  {
+    "text": "One strategy to improve coordination of care is the development of an adrenal nodule identification system which uses artificial intelligence natural language processing to create automated messages for PCPs regarding the nodule and guidelines for next steps.",
+    "tokenCount": 42,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2e5e82bdb84a4021428cb978f26660e47c3482754060c64c95014f07b6ec9260"
+  },
+  {
+    "text": "A recent study utilized artificial intelligence technology to flag patient electronic health records with adrenal nodules 32 and pairing similar technology with notifications to PCPs can be an effective way to reduce the amount of IAMs lost during the transition of care.",
+    "tokenCount": 48,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "b4aa1499bf364d934e7d3dc7e964dec8968aa0ca6897aaf26ce8c747330c0508"
+  },
+  {
+    "text": "Another problem contributing to incomplete IAM evaluation is radiologists recommending no further workup.",
+    "tokenCount": 17,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "535e4a58d06bac955f7096d65dc83c4ea43ac4bee9bbce0c7b079c981b495fb8"
+  },
+  {
+    "text": "Although radiologists rule out malignant potential and label the nodule as benign, biochemical workup is required to understand the functional potential.",
+    "tokenCount": 27,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2f1453dcbc48c5d5192cc919b4735acf9f5c5478ac163719dc509a3936ce73f2"
+  },
+  {
+    "text": "To combat the issue, the use of radiology reporting templates which encourage additional testing and provide specific followup recommendations have led to increased rates of followup imaging and biochemical testing.",
+    "tokenCount": 35,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a5316c7ad59eb3dcbfa10b731160671c1fef262fd8330cab432da25de5fff2fa"
+  },
+  {
+    "text": "33-35 While modifications to radiology reporting language (e.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c40503c7e08986888e63cc5ad5b37d0bc4284654e687148f9307982b75f16a63"
+  },
+  {
+    "text": ", low concern for malignancy, could consider a functional workup) are a step in the right direction, additional protocols and interdisciplinary teams are necessary to ensure even more patients are adequately evaluated.",
+    "tokenCount": 40,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "0d794fdb106b185853b9788314df2c8d0857048f1323cd9897191acb048ff761"
+  },
+  {
+    "text": "Recently, a program combining standardized radiologic reporting, chartbased messages to PCPs, and easier referrals to a multispecialty adrenal clinic resulted in an approximate 4x increase in the number of biochemical testing orders placed by PCPs.",
+    "tokenCount": 49,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "0e0c293aa01d5860b08972acf972110528af10b53dd92c3200af5adb03ff84cb"
+  },
+  {
+    "text": "36 Similarly, interdisciplinary collaboration between radiologists, EM physicians, nurse case managers, and PCPs resulted in 95% of ED patients with incidental radiology findings having followup plans for evaluation after discharge.",
+    "tokenCount": 41,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "e566176ef79efff7847706705523b836b3585a79ec6c6d4081bce94788e6063e"
+  },
+  {
+    "text": "37 While these interventions highlight the promising outcomes for incidentaloma management using providers from multiple areas of health care, no studies to date have examined if these interventions have reduced disparities in Fig.",
+    "tokenCount": 36,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "7e7ac7fec65082b0b85f4f3f8d70c9cd04d82b9c33088c38ffc75f8f83a8790f"
+  },
+  {
+    "text": "DST [ dexamethasone suppression test; HTN [ hypertension.",
+    "tokenCount": 16,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "62055d8ad3aac997b28fbfd1f2493b55939a5e4025e16c52ea3da8dbca6361a4"
+  },
+  {
+    "text": "Ordering provider ADI Advantaged ( < 50 percentile) Disadvantaged ( > 50 percentile) N% n % EM 74 54.",
+    "tokenCount": 29,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d4bce6fba25299343e5726b2661168153ec8b7ead42b9db3901b3bb966891781"
+  },
+  {
+    "text": "It is not hard to imagine positive resources directed to identify IAM patients may be unequally distributed and benefit wellresourced clinics.",
+    "tokenCount": 26,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "6417d285a6e174daaa8f314924dc903901135b0bc63d012e8aa94ff4b1c66945"
+  },
+  {
+    "text": "Thus, to further improve health outcomes and equity, interventions must consider the patient population and setting.",
+    "tokenCount": 19,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "ae4372db834f0626ff16707ac64d598ba9c63bae4b5be6bdc57032180b4150fb"
+  },
+  {
+    "text": "One relevant model to help achieve these goals is the Health Disparities Framework, developed by the National Institute on Minority Health and Health Disparities.",
+    "tokenCount": 30,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "101d4014dd5214de576935c5ac277890a899ea788a897e1c9eed98151baaea2a"
+  },
+  {
+    "text": "38 The adaptation of the socioecological model evaluates five domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) and drives research and interventions toward solutions which address the fundamental causes of disparities.",
+    "tokenCount": 48,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "62373bad51f2ae5eda97cd814c0068a4b3f87a32535b6034e6ecce91c6a6591c"
+  },
+  {
+    "text": "Building upon this and the findings of our study, we encourage researchers and doctors to consider patient and neighborhoodlevel disparities when implementing subsequent interventions.",
+    "tokenCount": 27,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "45d9622cb961af9a6d99298331bd5d0dbc703c5780a63d69dce27b1269d49b64"
+  },
+  {
+    "text": "We found a major obstacle for patients in disadvantaged communities is following up with PCPs after the identification of an IAM.",
+    "tokenCount": 24,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "3ab8b9b29bebbb3ac1865d2f33d59bb844871290403945ca8a82a0ba97e1107b"
+  },
+  {
+    "text": "Although we cannot determine the exact reason for each patient, one proposal could be the use of patient navigators who can help overcome environmental and neighborhood factors such as transportation, costs, and insurance coverage.",
+    "tokenCount": 39,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "76141c0abbc78ec07bffce9c06a47455c0e11e0518b1003bac56f4e541535f73"
+  },
+  {
+    "text": "This strategy has demonstrated success in improving cancer management and treatment.",
+    "tokenCount": 12,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "41cd72910a52d6fc865230f8a83d4cd4aeadf58fc1086ec92f21d6d387814e8b"
+  },
+  {
+    "text": "39,40 For instance, one randomized control trial found patient navigation led to significantly greater compliance with followup among minority women with abnormal mammograms.",
+    "tokenCount": 29,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "5ae1c9a95df8a04618b0e69895ae6384f1ae80897ae8b64db5b8f203f41e6c75"
+  },
+  {
+    "text": "41 As a result, navigators remain a promising method through which to eliminate disparities in care for IAMs, although obvious barriers such as costs and workflow burden require more indepth investigation.",
+    "tokenCount": 39,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "65cf0d099edec5cdb1be229c018683f4302ef6115f45c14b10b5892d554635ef"
+  },
+  {
+    "text": "Overall, the low rates of IAM followup, particularly among patients from disadvantaged neighborhoods, suggest the need for new protocols considering health disparities to ensure more patients are adequately evaluated.",
+    "tokenCount": 35,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "e17bb58f0ae949b381465ac593642c43a7dd076dba9be303c257c2e179704f12"
+  },
+  {
+    "text": "For one, retrospective data and inherent inaccuracies in the electronic medical record may skew results.",
+    "tokenCount": 18,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "b4d17b95df08e91edbbbc2f98c3045904be0027b80ad381d218ebd586664fdf8"
+  },
+  {
+    "text": "The data were only from a single institution and the population skewed more toward White and insured, making the results less generalizable.",
+    "tokenCount": 25,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "fb4acc152d6e7ef58b9ae0a6a96ce06b87660c4bdaad1eab9efc2bd2f88e8f17"
+  },
+  {
+    "text": "Including a greater percentage of nonWhite or Medicaid patients could allow for further elucidation of barriers to workup which specifically constrain these populations.",
+    "tokenCount": 29,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "701b17f48720354cde4c1fc21cb755af5914820b763d7db079edee67c1d4248f"
+  },
+  {
+    "text": "In addition, due to the retrospective nature, we cannot determine the direction of the relationship between neighborhood disadvantage and lower rates of biochemical workup.",
+    "tokenCount": 28,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "a553f8fd0620304e77d7b4bb2ad155eb7288652ea583cd4f75ae28ec66c57625"
+  },
+  {
+    "text": "We are also unable to determine any verbal or other communication provided to the patient regarding their identified nodule.",
+    "tokenCount": 21,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "288dedef3306b1b7d24248fc4bffa6141d08c267de0c2f337a49750449bed105"
+  },
+  {
+    "text": "Variable OR (95% CI) Sex Male ref Female 2.",
+    "tokenCount": 13,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "b5d6afdbd5fcf678bb680d4a1e03f256f003bbf04df341cb025cc68a862b5f6a"
+  },
+  {
+    "text": "31) Age > 65 ref < 65 1.",
+    "tokenCount": 10,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "a4a756c8e386b0c5150d0b286bc4114534c59860f71dd1e3b80988631ee8ed13"
+  },
+  {
+    "text": "73) Race/Ethnicity White ref Black 1.",
+    "tokenCount": 12,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "64100175afe7d9a0abc1c56ad17cc6cc33e17f02dfe53b3ce49654200a8433d0"
+  },
+  {
+    "text": "88) Other * Ordering provider ED ref PCP 4.",
+    "tokenCount": 13,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "f7efaf96b575f66ad766d238e8d1e9119bd7a73da50f5a49ec207eb5daba9f27"
+  },
+  {
+    "text": "01) ADI < 50 ref > 50 0.",
+    "tokenCount": 11,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "ecf3f50168a81aa53fe392b51c69a4b480f01e1b957659b8674c406db613cd81"
+  },
+  {
+    "text": "48) Tricare * * Not enough patients for analysis.",
+    "tokenCount": 13,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "5e12ce95ae834c8d671a63be3cae2ab51de8a8eb2ca75555995a5b5b0cefa759"
+  },
+  {
+    "text": "Table 4 e Common themes for lack of workup among disadvantaged patients Radiologist recommended no workup PCP did not acknowledge nodule Patient lost to followup Number of patients 11 13 6 Selected quote from Electronic Health Record Benign 1.",
+    "tokenCount": 47,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "c60bed8f5104a0f35e975c5c09988f9a194ba43bcbbfbfb243e2f68b7affeb9a"
+  },
+  {
+    "text": "No followup imaging is necessary Partially imaged, indeterminant 4.",
+    "tokenCount": 16,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "c90cbdf023d4820faddbfa6a75b8dbf44bf5203e489372e0dc832473bd40bd54"
+  },
+  {
+    "text": "6 cm right adrenal mass, likely adenoma or adrenal myelolipoma, both benign.",
+    "tokenCount": 23,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "3d9baf574ecc9efcbcaec9c2aba8951c9def0223a4e60103ed1f7db1177890b1"
+  },
+  {
+    "text": "Consider nonurgent adrenal protocol CT or MR for further characterization.",
+    "tokenCount": 14,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "084a6dc474c12da4d27436366881c609cb13a311a084353beb95de230186b87a"
+  },
+  {
+    "text": "Consider followup in 12 mo if no history of malignancy versus nonurgent evaluation with adrenal protocol CT or MRI.",
+    "tokenCount": 26,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "0c965f3f6891445cde4396c0cec1b7070290b5481adeb3fb9dfbf6add35c4dd2"
+  },
+  {
+    "text": "Discussed the need to complete testing for evidence of hypercortisolism or pheochromocytoma.",
+    "tokenCount": 24,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "2d631ae163737044fc47ac2130736998000d6b4ee026b032cfadc52b1f9d9dbf"
+  },
+  {
+    "text": "MR  magnetic resonance; MRI  magnetic resonance imaging.",
+    "tokenCount": 11,
+    "pageStart": 6,
+    "pageEnd": 6,
+    "hash": "7811b3d2bd18aca0fc3709090f32512c8c6ee4642c3343e8c4647e99cae9cc24"
+  },
+  {
+    "text": "Conclusions Overall, the rates of complete or partial guidelinebased biochemical workup of adrenal incidentalomas in our study population were low at 11% and 18%, respectively.",
+    "tokenCount": 34,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "ab29dfc491d0f875957e405a4d868a4615d1423b8840fd27ae1158d8ce3c9755"
+  },
+  {
+    "text": "Patient neighborhood disadvantage and studies ordered by EM providers were associated with lower rates of biochemical workup.",
+    "tokenCount": 20,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "3f02e39818ae2e75d049bcb3f2653dee5081fac9912c1e19ceb761af3fd5258b"
+  },
+  {
+    "text": "Further investigation into barriers to IAM workup and focused interventions to improve the rate of IAM workup for patients in disadvantaged settings are needed.",
+    "tokenCount": 29,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "6f7f027357380f514a13f3469b3062a84395c2f77b32b7bf4888dc332b112775"
+  },
+  {
+    "text": "Supplementary Materials Supplementary data related to this article can be found at https://doi.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "4162caf3be37d9c7e0740995ed2c0d87f86c09c17ec11a8bf79ae4e65ca27299"
+  },
+  {
+    "text": "OConnor reports that financial support was provided by Herman and Gwendolyn Shapiro Foundation.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "45d1652351fa4976f32e7075d70bd1f879daf13fc091f2a0fc9719a5d52e0fd8"
+  },
+  {
+    "text": "Amy Kind reports financial support was provided by National Institute on Aging.",
+    "tokenCount": 13,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "c4dd6dd922363d9e37582ecb39936ccf95ed8ec72dfd6b97a7599a941b0744cd"
+  },
+  {
+    "text": "The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.",
+    "tokenCount": 28,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "1ae57b40fce5c4bd15f235a228c19c92023efe715ef24ab0dc73c734bef06647"
+  },
+  {
+    "text": "CRediT authorship contribution statement John P.",
+    "tokenCount": 11,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "fb7a6f18b1e638cf02baae6ee52a61f1e520bdb1dfdd4d5e119880577c3d7e37"
+  },
+  {
+    "text": "OConnor: Writing e review & editing, Writing e original draft, Investigation, Formal analysis, Data curation.",
+    "tokenCount": 24,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "a47c0224bee0f19d4cdb9a569066bcb044abb180fb239dd89d390bb67e04e5b5"
+  },
+  {
+    "text": "Alekya Poloju: Investigation, Formal analysis, Data curation.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "5085a4802c9b2f99f6efc4f5bc04c3b020e867e3483b924419a7778025990478"
+  },
+  {
+    "text": "Pabich: Project administration, Methodology, Data curation.",
+    "tokenCount": 14,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "f8fda2c99701eb6d4a79f3e11b2a18cade50ef9211321a5d4caa981cf8baa2f3"
+  },
+  {
+    "text": "Betty Allen: Investigation, Data curation.",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "c66634c5fc63376477c587b92dc2c1e8741ee19458852a34d641bd33921632d2"
+  },
+  {
+    "text": "Rebecca Sippel: Supervision, Project administration, Methodology. Amy Kind: Supervision, Methodology.",
+    "tokenCount": 24,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "7fa71d2880dceb97dfb5e7eac80d09094a5bf73e92dfc3a8250cf177810d0785"
+  },
+  {
+    "text": "Alexander Chiu: Writing e review & editing, Validation, Supervision, Project administration, Methodology, Formal analysis, Data curation, Conceptualization.",
+    "tokenCount": 34,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "fb8a016dc56663bc054d0c4a598348770cc8fb792ce6358962019f76b92a24d4"
+  },
+  {
+    "text": "Sherlock M, Scarsbrook A, Abbas A, et al.",
+    "tokenCount": 15,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "093618d45a9d4a8058e05d06343d3c25f9d9cedcc40773757ae1cfb02db35a07"
+  },
+  {
+    "text": "Ebbehoj A, Li D, Kaur RJ, et al.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "9f5dfa8930683a67528a14321f5b849472d2372250210c6248f339589fe4cc84"
+  },
+  {
+    "text": "Epidemiology of adrenal tumours in Olmsted County, Minnesota, USA: a populationbased cohort study.",
+    "tokenCount": 24,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "18b148eb2ae9b0e1c0d2e2f123491483ddfdc3b0cf2269c6a0872f1314fa3772"
+  },
+  {
+    "text": "2020;8:894 e 902 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "51220a02a3c4be68dab4d2f6ca4b15406ed6da3c384a0ab98a2e7aeff603f116"
+  },
+  {
+    "text": "Geelhoed GW, Druy EM.",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "71ca7b3d6a27d97e0418165faa7f4571b6624043ca3ee313a7df9ab4c646dc80"
+  },
+  {
+    "text": "Fassnacht M, Arlt W, Bancos I, et al.",
+    "tokenCount": 18,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "69b8cb9aa836ab6c98527e551b45cb42cdb109871c72614baa391690df93ac40"
+  },
+  {
+    "text": "Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors.",
+    "tokenCount": 30,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "1d77f0256866fc034e930e45ea3fe381fcd4ebd4d1773357c5b22d89c6f2921d"
+  },
+  {
+    "text": "2016;175:G1 e G34 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "a7a83f30fd6b8cee2fc5cc709062e1a209a0ec78b979f74410348acf18fb45f7"
+  },
+  {
+    "text": "Song JH, Chaudhry FS, MayoSmith WW.",
+    "tokenCount": 14,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "34ff139bbb24d2ccd0297933168af6032a9548c76c48cf3691ad1fc54632fea3"
+  },
+  {
+    "text": "The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with No known malignancy.",
+    "tokenCount": 31,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "bbb3aae7e5015002526c7472fb5fcfc3b321cca5001e5c7e118500c989998106"
+  },
+  {
+    "text": "2008;190:1163 e 1168 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "8e0eec3ff4f004111e587d40aab0478c0aa42dcb81c7d79d6c1befd3b01a9ba6"
+  },
+  {
+    "text": "Zeiger MA, Thompson GB, Duh QY, et al.",
+    "tokenCount": 15,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "8338205c67d92ed7c06313449c10edebf3bfb86dc62078c0586fe006f03be49d"
+  },
+  {
+    "text": "American association of clinical endocrinologists and American association of endocrine surgeons medical guidelines for the management of adrenal incidentalomas.",
+    "tokenCount": 25,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "a41e9b73d4fd5961a04edeac3116f33090b5ec1be8fba7db754b07799ef59797"
+  },
+  {
+    "text": "Yilmaz N, Avsar E, Tazegul G, Sari R, Altunbas H, Balci MK.",
+    "tokenCount": 30,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "bd09ec7044dcbf10f734a87d5ed6a9bddf9364fdc2b00bd106867079af20fcdb"
+  },
+  {
+    "text": "Clinical characteristics and followup results of adrenal incidentaloma.",
+    "tokenCount": 13,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "c4ff52da4f5eaff51306db1e4b32ef03269cc834ee7de7ea9ef2461a0865bf44"
+  },
+  {
+    "text": "Sconfienza E, Tetti M, Forestiero V, Veglio F, Mulatero P, Monticone S.",
+    "tokenCount": 28,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "98d25b140e2a68503d8a69a4e27e026a9d17ed731ec626b4cb228e38bb02518c"
+  },
+  {
+    "text": "Prevalence of functioning adrenal incidentalomas: a systematic review and metaanalysis.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "047cf3b7dc843ece59e0f9a4e8d0631316e8c6c18c9a8c3bb2da16efb016f113"
+  },
+  {
+    "text": "2023;108:1813 e 1823 .",
+    "tokenCount": 11,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "34698fa52126e2b783e84397401df14181a3a2b307de3085dbf9ea25d93fe535"
+  },
+  {
+    "text": "Maas M, Nassiri N, Bhanvadia S, Carmichael JD, Duddalwar V, Daneshmand S.",
+    "tokenCount": 29,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "99b665d8131195c422a5b5d728045265cbae3ce8ec35d327f9de3bc4455e5f9e"
+  },
+  {
+    "text": "Discrepancies in the recommended management of adrenal incidentalomas by various guidelines.",
+    "tokenCount": 16,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "5ab37d98a2c6874c513348084b650aa34dd1904403ef831317ddc3439e71f082"
+  },
+  {
+    "text": "Taya M, Paroder V, Bellin E, Haramati LB.",
+    "tokenCount": 16,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "69fc44f9ce85cc88f39dc914f40370e00250f12e7fa1bc84d5d8537ffdc9c3bb"
+  },
+  {
+    "text": "The relationship between adrenal incidentalomas and mortality risk.",
+    "tokenCount": 11,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "11bd4a045843b1a9b993e06f3282416645e404813b9f0902ad6da4162765ba31"
+  },
+  {
+    "text": "2019;29:6245 e 6255 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "8df1a4873d289be6bb774f278b121eb3c136974aa73dda8717b174075c1089e6"
+  },
+  {
+    "text": "Di DG, Vicennati V, Garelli S, et al.",
+    "tokenCount": 16,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "169afbf22fac7910b2d4d756cee983896e0940e2906e3a5227ccdcf6d9f31c7e"
+  },
+  {
+    "text": "Cardiovascular events and mortality in patients with adrenal incidentalomas that are either nonsecreting or associated with intermediate phenotype or subclinical Cushings syndrome: a 15-year retrospective study.",
+    "tokenCount": 39,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "3571ed39d1efbaea4a855d700c3f333abae1f5e87a90c18ef36294673e51d3b1"
+  },
+  {
+    "text": "Feeney T, Madiedo A, Knapp PE, Gupta A, McAneny D, Drake FT.",
+    "tokenCount": 25,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "8ba4a095941ef8b4ed236298f40896b9895605f2f8490609fb88d5bb03df3bb4"
+  },
+  {
+    "text": "Incidental adrenal masses: adherence to guidelines and methods to improve initial followup: a systematic review.",
+    "tokenCount": 21,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "036c49bc6ddc38a7072b800eb0540eaed4f56821d6954d85d5d101dcc394a2dc"
+  },
+  {
+    "text": "Cho JK, Zafar HM, Lalevic D, Cook TS.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "a5ed3c67924ade06379395717a50f645240e11840c99ac6bfa8e5ff11cb3f29a"
+  },
+  {
+    "text": "Patient factor disparities in imaging followup rates after incidental abdominal findings.",
+    "tokenCount": 14,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "2d387c7d030e7b6eaea9705e58c1affe9397d2bd884857d10fba9030b91b0dbf"
+  },
+  {
+    "text": "Liao GJ, Liao JM, Lalevic D, Zafar HM, Cook TS.",
+    "tokenCount": 22,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "1264659814a87e5aff026be386209a0d0c830c73b8842d35e9f599e170cbf7cf"
+  },
+  {
+    "text": "Location, location, location: the association between imaging setting and followup of findings of indeterminate malignant potential.",
+    "tokenCount": 24,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "6dae9d393c2843e3dce60130fc41698ca40cdcf2880ceb921efd68b6f6bd7db6"
+  },
+  {
+    "text": "Charlson ME, Pompei P, Ales KL, MacKenzie CR.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "56e6d6e12746072329ba49954c50345ba9d0246edc7c8825609684865512d67e"
+  },
+  {
+    "text": "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.",
+    "tokenCount": 20,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "77a09851bbcdacd052778fbdb26fab346e4e01e1bd10a7c520e780795bb82a94"
+  },
+  {
+    "text": "Area deprivation and widening inequalities in US mortality, 1969-1998.",
+    "tokenCount": 13,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "e054e440f10f9d10d1c9aaba8da5c30f10df4adda39ddb2b1dd9ab573248ac79"
+  },
+  {
+    "text": "2003;93:1137 e 1143 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "84fa4a29583224515714cd935d6813c7b87b38030bd059b4715756c472d5b52b"
+  },
+  {
+    "text": "Making neighborhooddisadvantage metrics accessible d the neighborhood atlas.",
+    "tokenCount": 13,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "21c29d06a10dc69208d162cb96d2c136cff44dc0fe732cf41ab820a3542112be"
+  },
+  {
+    "text": "Hu J, Kind AJH, Nerenz D.",
+    "tokenCount": 12,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "37280d5653c9e510aaa30a0ec1352eb6c6a95d0fd6fe5bc6c2520087c23f90be"
+  },
+  {
+    "text": "Area deprivation index predicts readmission risk at an urban teaching hospital.",
+    "tokenCount": 13,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "2be42de050e2fd0de1275159af2a41bb42ddd073f1df669918b9a888a6ab7dfe"
+  },
+  {
+    "text": "Shen J, Fuemmeler BF, Sheppard VB, et al.",
+    "tokenCount": 18,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "b0e8b600f521aa5cf1b2ee3cf9c1a327769e5bed0f06092511313cdfceb4e292"
+  },
+  {
+    "text": "Neighborhood disadvantage and biological aging biomarkers among breast cancer patients.",
+    "tokenCount": 14,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "97898a898eb137578e8fbf49165c77a42068b06e1abaa40ee187dca2fd3610b7"
+  },
+  {
+    "text": "Maher DI, Williams E, Grodski S, Serpell JW, Lee JC.",
+    "tokenCount": 20,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "187e0bf10b539e801bd63bf9dc79921d271d956d6e05f73062630b24b650ba14"
+  },
+  {
+    "text": "Adrenal incidentaloma followup is influenced by patient, radiologic, and medical provider factors: a review of 804 cases.",
+    "tokenCount": 27,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "0043e993b6225dd4cf3bb890b2926c547b204b2d3536c39120f05c8c78a48215"
+  },
+  {
+    "text": "2018;164:1360 e 1365 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "83fd493120eae80ab7b9d9a3b40f893d382431a45cc5528a8919b8cab1c7b4aa"
+  },
+  {
+    "text": "Morelli V, Reimondo G, Giordano R, et al.",
+    "tokenCount": 17,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "183a8c6bdaf2abf16446573c79adbd028439e97bc3614a37038458c19ec6c33d"
+  },
+  {
+    "text": "Longterm followup in adrenal incidentalomas: an Italian multicenter study.",
+    "tokenCount": 16,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "8ce3ca41bfe892914e8613ec128d7f1d8ef5971a54a754acb33b1d572b9acb53"
+  },
+  {
+    "text": "2014;99:827 e 834 .",
+    "tokenCount": 10,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "3400e5baa08ba993a9ac6396fabbae234d7bebce1d89329037a382633b14b4c9"
+  },
+  {
+    "text": "Durfey SNM, Kind AJH, Buckingham WR, DuGoff EH, Trivedi AN.",
+    "tokenCount": 24,
+    "pageStart": 7,
+    "pageEnd": 7,
+    "hash": "3dc216abbcfd86a2b0f2aa72c1abceed45c75a19491ad06ff01d6fc0625fd27b"
+  },
+  {
+    "text": "Kirby JB, Kaneda T.",
+    "tokenCount": 10,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "965e2fe8849409ad025450441a1c2e836dee88a3260814113314a02269fcbe88"
+  },
+  {
+    "text": "Neighborhood socioeconomic disadvantage and access to health care.",
+    "tokenCount": 11,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "5e38af91c1f1ba4af706feb7105e655d4880d34f6c34ef3fd66185a4cd6e6d4b"
+  },
+  {
+    "text": "Schut RA, Mortani Barbosa EJ.",
+    "tokenCount": 11,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "31982e079455f47e7a5849668ab4e34d14359ea0f0109905d26af6b12dd3c02d"
+  },
+  {
+    "text": "Racial/ethnic disparities in followup adherence for incidental pulmonary nodules: an application of a cascadeofcare Framework.",
+    "tokenCount": 24,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "3aea117c2df61a44ec61601eba461159637dbe66154384e85ec95605e8dd3046"
+  },
+  {
+    "text": "2020;17:1410 e 1419 .",
+    "tokenCount": 10,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "7746595031bdc3c9b418a98d9e0aec9b03d0c0d346640853fcbade1e5b972048"
+  },
+  {
+    "text": "Abrahamowicz AA, Ebinger J, Whelton SP, CommodoreMensah Y, Yang E.",
+    "tokenCount": 23,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "d8077abbd118450d8bd09da27b1068cc79cff318d6fe622132e2e48fa32b2f67"
+  },
+  {
+    "text": "Racial and ethnic disparities in hypertension: barriers and opportunities to improve blood pressure control.",
+    "tokenCount": 17,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "66e4fee6d23336eeb4fa9fd1ae54df6e0272987147d383ee1263fdf194ac565c"
+  },
+  {
+    "text": "Hassan S, Gujral UP, Quarells RC, et al.",
+    "tokenCount": 19,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "d3e902bf5cb6cf84d1f420a4bbcaf461289ec5f85fd828b094c3dbf6853f1f25"
+  },
+  {
+    "text": "Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward.",
+    "tokenCount": 21,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "790efb3eebf3f1b1254075e35f0ca28af769e201aa89fae2df09b48583708cbc"
+  },
+  {
+    "text": "2023;11:509 e 524 .",
+    "tokenCount": 10,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "7754cbe39abdfd033b15089a02f7075ba9decf58e24b2e122ac49e0ed7cc85ea"
+  },
+  {
+    "text": "Hussein M, Diez Roux AV, Field RI.",
+    "tokenCount": 14,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "972c0c522392d540fffe924243f70157cece87b48b3ebce438419d6577d4ceff"
+  },
+  {
+    "text": "Neighborhood socioeconomic status and primary health care: usual points of access and temporal trends in a major US urban area.",
+    "tokenCount": 24,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "269c24f02a9e1a8d554d4f952a826096e4b5b047b6d5b9a381c0e39639da55cc"
+  },
+  {
+    "text": "Nwana N, Chan W, Langabeer J, Kash B, Krause TM.",
+    "tokenCount": 19,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "b139a3cd87345c2170d0e65d3e25eabde6d385ae3ef09a42f02629fdff57be42"
+  },
+  {
+    "text": "Association of neighborhood socioeconomic disadvantage with hospital quality in US metropolitan settings.",
+    "tokenCount": 14,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "d287be72aa08619298bd255740c17c6521662444b65b74de509be5310c9e2495"
+  },
+  {
+    "text": "Feeney T, Talutis S, Janeway M, et al.",
+    "tokenCount": 17,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "ebf989ea08a9a5479711f1f1e95dce602288646c6a714856dfc064730b312329"
+  },
+  {
+    "text": "Evaluation of incidental adrenal masses at a tertiary referral and trauma center.",
+    "tokenCount": 17,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "0181d60f097398cfaad12af4b4624e0f87592bcf13b47ac83eba79331c5dd5a2"
+  },
+  {
+    "text": "2020;167:868 e 875 .",
+    "tokenCount": 10,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "13ed76ebd727eb70fee58d294fe8e3955a04972a8d525935b169c94e6b45376a"
+  },
+  {
+    "text": "Becker J, Woloszyn J, Bold R, Campbell MJ.",
+    "tokenCount": 16,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "38c11e2ca40e15f55fd7cbab6e8b3d5fb803fdbc5dad5fa25a5c43c7e36e90da"
+  },
+  {
+    "text": "The adrenal incidentaloma: an opportunity to improve patient care.",
+    "tokenCount": 13,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "062b17e9d25416a0b2f42b9f636ea95cbaef068b2dcce43b9e06c34223ceaef6"
+  },
+  {
+    "text": "Talutis SD, Childs E, Goldman AL, et al.",
+    "tokenCount": 15,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "65b13892029a3197338e290e9c8f7de3c42ee2704571d98506f7655dc494fd2b"
+  },
+  {
+    "text": "Strategies to optimize management of incidental radiographic findings in the primary care setting: a mixed methods study.",
+    "tokenCount": 22,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "75d38e8bcdaf2b32b2d01414bdf372ba05a306cf08c64da644b7479a9ddc949f"
+  },
+  {
+    "text": "Schumm M, Hu MY, Sant V, et al.",
+    "tokenCount": 13,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "db4e7b02ff9b16e7e48e0125c00aa74d6b575a95e37faee92c8475b32ce86674"
+  },
+  {
+    "text": "Automated extraction of incidental adrenal nodules from electronic health records.",
+    "tokenCount": 14,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "29dd5f5c789172632dee282770ee96b2da0cbcafb20caf528f8f6807c832224c"
+  },
+  {
+    "text": "Woods AP, Godley F, Feeney T, et al.",
+    "tokenCount": 16,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "a10112690910392a7dd83bea6c09482ba4f8ca7a130f24f0ba42efa6b57ea3e5"
+  },
+  {
+    "text": "A standardized radiology template improves incidental adrenal mass followup: a prospective effectiveness and implementation study.",
+    "tokenCount": 20,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "969b655698dc5330ae027ed5cf15ad0d774bab1e471480eaacd01a3179f5919c"
+  },
+  {
+    "text": "Hamilton AE, Green RL, Gao TP, et al.",
+    "tokenCount": 13,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "dcd9999058eca7a1f2f33c5b903363f02bf0c8b98180346fa22a4a19f3cf4ad1"
+  },
+  {
+    "text": "To report hounsfeld units or not: there is no question.",
+    "tokenCount": 15,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "67d456c91d7d2983fe268f4d47223926fc512ad7c7f42351bb76e6057143c715"
+  },
+  {
+    "text": "Watari J, Vekaria S, Lin Y, et al.",
+    "tokenCount": 15,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "d80ed9928a67697afcec2b3d9a128c4082d3ffa984687d79e52be99370c7aa8f"
+  },
+  {
+    "text": "Radiology report language positively influences adrenal incidentaloma guideline adherence.",
+    "tokenCount": 14,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "bf22af7f18562958710c589035ac7f4f6476debea1c425d28336ff07b7b7b39d"
+  },
+  {
+    "text": "Woods AP, Feeney T, Gupta A, Knapp PE, McAneny D, Drake FT.",
+    "tokenCount": 24,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "37389d94074191367fe3d4ffb63d7eba7de3ee15ca00e383224a7ffbe3335054"
+  },
+  {
+    "text": "Prospective study of a systemwide adrenal incidentaloma quality improvement initiative.",
+    "tokenCount": 15,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "347150460e82ed01a8166ac0b7f742952d5855b0de49c81c309a25e19bbda416"
+  },
+  {
+    "text": "2024;238:961 e 970 .",
+    "tokenCount": 10,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "3c6eb1f6b2aa8ebb38d4f37f3c2b07dacbfb965c76f789494e9b58dd3bf77432"
+  },
+  {
+    "text": "Barrett TW, Garland NM, Freeman CL, et al.",
+    "tokenCount": 13,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "0ef64c503581fe608a049cc53e1d363feb88d65566aaee184612eea8ddcd004a"
+  },
+  {
+    "text": "Catching those who fall through the cracks: integrating a followup process for emergency department patients with incidental radiologic findings.",
+    "tokenCount": 24,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "b4aacde5d17aa8de8e73dbcb0e0d768d8eb9429addf4bcb9d561e68ed9c40a8b"
+  },
+  {
+    "text": "Alvidrez J, Castille D, LaudeSharp M, Rosario A, Tabor D.",
+    "tokenCount": 22,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "c6387dbbcfb526fe21ffce5095de7ccf9c1e855eb64910b285649d030a9fd6ef"
+  },
+  {
+    "text": "The national Institute on minority health and health disparities research Framework.",
+    "tokenCount": 12,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "2fa126cf046149d6551b20eb1663885247154b4e532c246ea4228abc7cfc35a5"
+  },
+  {
+    "text": "2019;109:S16 e S20 .",
+    "tokenCount": 10,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "f55ca7c29304bb66fb6170134aa1da02bc66906cd2bc7f3bd25d4683cb59c424"
+  },
+  {
+    "text": "Freund KM, Battaglia TA, Calhoun E, et al.",
+    "tokenCount": 16,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "83a291b01e91c3655f6698d1a47cbacd321a0039452fbdf570d75e80820386d8"
+  },
+  {
+    "text": "Impact of patient navigation on timely cancer care: the patient navigation research program.",
+    "tokenCount": 16,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "91cfa318c664c00ef66d7ba86908704dbbf3a8959040183894991156c736070d"
+  },
+  {
+    "text": "Shusted CS, Barta JA, Lake M, et al.",
+    "tokenCount": 14,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "f82ab4b0e90f6374c920a3d4afdc8471a2b9936b96810689585af3f907e3fa20"
+  },
+  {
+    "text": "The case for patient navigation in lung cancer screening in vulnerable populations: asystematicreview.",
+    "tokenCount": 18,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "461797f356519199b18311c64a2cd53a8d76a4f09c3ef5563745d88b7f8d28e4"
+  },
+  {
+    "text": "Ell K, Vourlekis B, Lee PJ, Xie B.",
+    "tokenCount": 16,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "570fb11d6264b933d4392769a06da726ac436403e2d0951bc88d0f25e8d78508"
+  },
+  {
+    "text": "Patient navigation and case management following an abnormal mammogram: a randomized clinical trial.",
+    "tokenCount": 17,
+    "pageStart": 8,
+    "pageEnd": 8,
+    "hash": "6f13097334c21aa54b8436b069b0260a568a70c78347c52e8fdf0751ad45ba0d"
+  }
+]

primary-aldosteronism Family Medicine Clinical Guidelines.pdf_semantic.json

@@ -0,0 +1,1570 @@
+[
+  {
+    "text": "September 2023  Volume 108, Number 3 www.",
+    "tokenCount": 11,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "78098a0123730b42a8d892eb16ac45e756f45f80d58654ef4bd8d317bed179b5"
+  },
+  {
+    "text": "org/afp American Family Physician 273 Primary aldosteronism, first described by Dr.",
+    "tokenCount": 21,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "e25f5cefbc49bafa6b65a3329f2b064f142706d6fe0413fb9290156e4d359a8a"
+  },
+  {
+    "text": "Jerome Conn in 1955, has long been considered a rare secondary cause of hypertension.",
+    "tokenCount": 17,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "f595030d615b1c10b8f3fd4a0c45b53823bdf0358c6c9967a7ec83e69aee7c44"
+  },
+  {
+    "text": "1 Newer evidence, however, suggests that primary aldosteronism is common and largely underrecognized.",
+    "tokenCount": 23,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "9fca5f0a0bd4cb019f3d4330fee4aee5bf6315614bbbd1d33f92974eed0c74c7"
+  },
+  {
+    "text": "It has been shown to be the underlying cause of hypertension in about 6% of patients in primary care settings 2 and in more than 20% of patients with stage 2 hypertension.",
+    "tokenCount": 35,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "43130cc18e496545e5565e7425e57e76cb58dd265b228257657cc85a8ec3862f"
+  },
+  {
+    "text": "3 Even for patients with an indication for case detection, appropriate testing is performed in only 1.",
+    "tokenCount": 19,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "f4b09898a0d05ae03b77d89e0619904a35c2d416f4259f8900103ad149b1d732"
+  },
+  {
+    "text": "4,5 This underrecognition of primary aldosteronism can lead to delayed diagnosis and treatment, which can cause irreversible endorgan damage.",
+    "tokenCount": 30,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "741a04400aa35c9a7e4c939d9ec800d688ba6d00de977d5f88ab90b85c8e3a79"
+  },
+  {
+    "text": "6 Background Primary aldosteronism is the overproduction and oversecretion of aldosterone, occurring independently of the reninangiotensinaldosterone system (RAAS).",
+    "tokenCount": 38,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "fd7d669074c609d725fd7fc963f4250f460b946c59249be740abec438f3c6538"
+  },
+  {
+    "text": "Aldosterone can cause sodium retention and potassium excretion in the renal tubules.",
+    "tokenCount": 17,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "2e22069c977a4587fdab4c98dce8bb0f3dda84ef2076d7ecccc6ac98eee7add3"
+  },
+  {
+    "text": "Aldosterone (mineralocorticoid) receptors are also present in vascular endothelial smooth muscle cells and the myocardium.",
+    "tokenCount": 28,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "3b8fe2ab6b4ca045e44d0058002783c8d23e39b0d2ea8018706368dc0a262a37"
+  },
+  {
+    "text": "Chronic activation of these receptors is associated with proinflammatory and profibrotic effects, 7 likely explaining the increased risk of cerebrovascular, cardiovascular, and renal disease in primary aldosteronism compared with essential hypertension 8-12 (Table 1 10 -12 ) .",
+    "tokenCount": 57,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "a6ddb2592e62e4e54f8291736d1c96a08853d1c62837b1c82bb38e15f65d73a9"
+  },
+  {
+    "text": "(Bruin) Rugge, MD; and Olga Senashova, MD Oregon Health & Science University, Portland, Oregon CME This clinical content conforms to AAFP criteria for CME.",
+    "tokenCount": 42,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "db844d9d063cdfe02f592677024772eefb4d60a153f2d764c8ae4bb11163df17"
+  },
+  {
+    "text": "Primary aldosteronism is the underlying cause of hypertension in primary care settings in approximately 6% of cases, and it is even more common in patients with resistant hypertension.",
+    "tokenCount": 35,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "65cbb24a4c77dfd6559f05c48eae44168af0d32453899df09f9387b43e0d5dd4"
+  },
+  {
+    "text": "However, it is estimated that only about 2% of patients who have risk factors for primary aldosteronism have been formally tested or diagnosed.",
+    "tokenCount": 30,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "6aba630216ecefe5ab4c43cb91c3facb5bb7b980a312eecb323adda4e44d486c"
+  },
+  {
+    "text": "The first step in the diagnosis of primary aldosteronism is case detection and involves testing patients who are at risk, including individuals with resistant hypertension, as well as those with wellcontrolled hypertension and a firstdegree relative with primary aldosteronism, hypokalemia, an adrenal nodule, atrial fibrillation, obstructive sleep apnea, or a family history of an early stroke (i.",
+    "tokenCount": 86,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "04cc64a93df034cacd7c44b00ed8e12c83e7f07cec11509ee71258fdf81a0d7d"
+  },
+  {
+    "text": "Initial case detection is performed by simultaneously measuring plasma aldosterone concentration and plasma renin activity; an elevated aldosteronerenin ratio (greater than 30) indicates independent aldosterone secretion (i.",
+    "tokenCount": 42,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "210a6d263130092cfda7a07822cf92474cd80d360fc55603c71d479bc06c01ed"
+  },
+  {
+    "text": "After a positive case detection, confirmatory testing should be performed.",
+    "tokenCount": 13,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "3777be425e9360f55dac7901165aae652afc8e5b664ca3d061322727e60a1acc"
+  },
+  {
+    "text": "Confirmatory tests include the captopril challenge, oral or intravenous salt loading, or fludrocortisone suppression.",
+    "tokenCount": 27,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "232a9c88d2992fafd0330d324d9743eccdde212141b194dc9074f0b3ce5bb8ce"
+  },
+  {
+    "text": "Results are positive if aldosterone levels remain high after interventions that suppress or interrupt physiologic production of aldosterone.",
+    "tokenCount": 24,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "26d86eed294d92db44c19b5a06d15f5e3d0e5baeba07c8e842f3cc0490e900e0"
+  },
+  {
+    "text": "If the confirmatory test is positive, adrenal computed tomography and adrenal vein sampling should be performed to differentiate unilateral from bilateral adrenal production of aldosterone.",
+    "tokenCount": 34,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "574c7ab276853fbebe1d758af6f42f20f5fdfd6842a93e7a2919dd546935dda7"
+  },
+  {
+    "text": "Patients with unilateral primary aldosteronism should undergo adrenalectomy, whereas those with bilateral production should be treated with mineralocorticoid receptor antagonists, such as spironolactone or eplerenone.",
+    "tokenCount": 46,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "3e80b46c37dd0439fbdde0ebf6fb1724f4999b88ea4adb0304f915a16bff1366"
+  },
+  {
+    "text": "2023; 108(3):273-277.",
+    "tokenCount": 11,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "7734fbb05ad1a2f88faa9385f0aa7e0003b2ef0f64521846ddbf26aa02a67133"
+  },
+  {
+    "text": "Copyright  2023 American Academy of Family Physicians.",
+    "tokenCount": 10,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "74198e7cc33b1d67c407b461ce4f22253b51010de199a4f4a969b0cc067c2365"
+  },
+  {
+    "text": ") TABLE 1 Adverse Effects of Primary Aldosteronism Compared With Essential Hypertension Risk Odds ratio (95% CI) Atrial fibrillation 3.",
+    "tokenCount": 34,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "9819cff9e87f6bbf0d775fcac0b2cc9509f3a857810de1394f1424cb8cc23b7b"
+  },
+  {
+    "text": "45) Left ventricular hypertrophy 2.",
+    "tokenCount": 10,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "925e04a7899418b9b99bf5c4bc5f271a23d3f36aaf98187ef61566270906f658"
+  },
+  {
+    "text": "Downloaded from the American Family Physician website at www.",
+    "tokenCount": 12,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "fa4f80ff9dcfaa4a7c148facd542059d6e8c9328675b16422b4a28ffc15cba30"
+  },
+  {
+    "text": "For the private, noncommercial use of one individual user of the website.",
+    "tokenCount": 15,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "14e67a948643ee4635781c166e20e7a147f0278be7b44ef2a9c359d42098d8c7"
+  },
+  {
+    "text": "org for copyright questions and/or permission requests.",
+    "tokenCount": 10,
+    "pageStart": 1,
+    "pageEnd": 1,
+    "hash": "ca8bf4b330cd6e3d1751b8fc42790f445843bb887abeece320fe347960a22e5e"
+  },
+  {
+    "text": "org/afp Volume 108, Number 3  September 2023 PRIMARY ALDOSTERONISM Case Detection The first step in diagnosing primary aldosteronism is case detection.",
+    "tokenCount": 40,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "91b9f53e41bd978daf3d2ccd9489ae6a5b3970f5015520388b8db9c61449f727"
+  },
+  {
+    "text": "Current guidelines recommend performing case detection in patients with resistant hypertension, as well as those who have wellcontrolled hypertension with certain clinical characteristics (Table 2) .",
+    "tokenCount": 30,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "e0b8bb6f20e228226003ed3654a4a3a6978975752f3061cfdc2e60d2e66d296f"
+  },
+  {
+    "text": "13 Normokalemia should not dissuade clinicians from considering the diagnosis of primary aldosteronism.",
+    "tokenCount": 22,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "557d075ec71c7d36dfd8092685d12c995550a1814bb9ab6ef2fffbd8035b5a7b"
+  },
+  {
+    "text": "Hypokalemia is the exception, not the rule, and is seen in only about 30% of patients with primary aldosteronism.",
+    "tokenCount": 30,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "7ea001ab40a655b194c6a65a867d30ae2387af43f07518b28ebe9af58b98d1af"
+  },
+  {
+    "text": "14 Initial case detection for primary aldosteronism is performed by simultaneously measuring plasma aldosterone concentration and plasma renin activity.",
+    "tokenCount": 27,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "a9a7bd8c3fc993b8256248f2aef01824aac09c323e4e636b5444618e77916777"
+  },
+  {
+    "text": "10 Aldosterone elevation with suppressed plasma renin activity identifies patients with potential primary aldosteronism 10,13 (Figure 1 10,13,15 ) .",
+    "tokenCount": 33,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5f6b08d5fdfa25202b8a3f42759dcbaf557736f8beaf9feaf5dde7d7e8ed3c60"
+  },
+  {
+    "text": "An aldosteronerenin ratio of greater than 30 is considered positive.",
+    "tokenCount": 15,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "bf1d3f22d4dfab82cb06d1eec29cc09e28571fe4554adcf682374b5d15c285a0"
+  },
+  {
+    "text": "Medications that significantly alter the RAAS, such as spironolactone, eplerenone, and amiloride, are ideally held before testing and, if needed, other antihypertensives should be substituted (Table 3) .",
+    "tokenCount": 52,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "a49d3b59238e8c0a3ba505d0473ac199018a25f3b562d30ff63eec0aa8144fd2"
+  },
+  {
+    "text": "13 Confirmatory Testing Confirmatory testing is often needed to make a formal diagnosis of primary aldosteronism.",
+    "tokenCount": 25,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "3bc7939e2438232b303f72070525dade9bd4e0cf905cd8a291084fce377a4933"
+  },
+  {
+    "text": "However, in some patients with a high probability of primary aldosteronism based on clinical presentation and initial biochemical screening (e.",
+    "tokenCount": 27,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "b75b86f251c9c85e91ad8ae43de7d5098619fd13d77b18134a64944431140c51"
+  },
+  {
+    "text": ", spontaneous hypokalemia [potassium level of less than 3.",
+    "tokenCount": 15,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "3d56b2ee805c91b25eae0f0d66974da77eabd26ad9918f961652c3813e29725a"
+  },
+  {
+    "text": "5 mEq per L] with suppressed plasma renin activity and elevated plasma aldosterone concentration), confirmatory testing can be omitted.",
+    "tokenCount": 28,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "742daaafe8cc426e55161f7ddbb3f5690fd807ade3a7c0133430c2d3272b420e"
+  },
+  {
+    "text": "16 Confirmatory testing had a near 100% specificity for a final diagnosis of primary aldosteronism in cases where plasma aldosterone concentration was greater than 30 ng per dL and plasma renin activity was less than 0.",
+    "tokenCount": 48,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "d60c0d50e7db4a60b323216446428982b1443f25b9905ff2c21e3208fe1cdb0b"
+  },
+  {
+    "text": "15 For patients who require confirmatory testing, several tests are available, but there is no consensus on which one is preferred.",
+    "tokenCount": 25,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "c739c7aad798696bee66ea620059e72ac5816157452dcb900de923e5eb848b9d"
+  },
+  {
+    "text": "17 Test results are considered positive when aldosterone levels remain elevated despite an intervention that would suppress physiologic aldosterone production.",
+    "tokenCount": 26,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "f301f3ad53fb3affbf799b061619489b7452372f63452fc6b0d3ca32f95d9ecf"
+  },
+  {
+    "text": "Salt loading and synthetic mineralocorticoid administration can worsen hypertension and hypokalemia; therefore, monitoring of blood pressure and serum potassium levels is recommended.",
+    "tokenCount": 32,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "8d1b5ab382f9c3346318a5a99219daffa82f4f060f3d0423396309465157406b"
+  },
+  {
+    "text": "These tests are timeconsuming and require meticulous attention to detail; therefore, physicians may consider referral to an endocrinologist for confirmatory testing.",
+    "tokenCount": 28,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "0cca28baa218e28143ccdc48dd219f18afa0c9f66b4f95b6634f3ccd3c53b3fe"
+  },
+  {
+    "text": "CAPTOPRIL CHALLENGE TEST In the captopril challenge test, aldosterone levels are measured at baseline and then two hours after oral administration of 25 to 50 mg of the angiotensinconverting enzyme inhibitor captopril.",
+    "tokenCount": 51,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "f114e8658f42e7a67f1956535fc671bedc0ea0fcc575ebeb13e085ce6aa045bd"
+  },
+  {
+    "text": "In patients without primary aldosteronism, interruption of the RAAS by an angiotensinconverting enzyme inhibitor will cause a significant decrease in plasma aldosterone levels.",
+    "tokenCount": 37,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "278283ff31b6902074dcee35e0170b7e53e81218763edc8b6b4b7869b66937f6"
+  },
+  {
+    "text": "A decrease of less than 30% is consistent with autonomous aldosterone secretion (i.",
+    "tokenCount": 18,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "a818d78008e45b913752c299c06ade47220795572d8b8a3104a03f92dfc69255"
+  },
+  {
+    "text": "SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Evidence rating Comments Case detection for primary aldosteronism should be done in patients with resistant hypertension and in patients who have wellcontrolled hypertension with hypokalemia, atrial fibrillation, obstructive sleep apnea, adrenal incidentaloma, a firstdegree relative with primary aldosteronism, or a family history of early stroke (i.",
+    "tokenCount": 88,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "92473683a489423115487bc864acd7b285a6fbbd5ad95ae81e30bedf0a26d599"
+  },
+  {
+    "text": "11,13 C Expert opinion and limitedquality diseaseoriented evidence Initial case detection for primary aldosteronism is performed by simultaneously measuring plasma aldosterone concentration and plasma renin levels.",
+    "tokenCount": 38,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "afa667127742069592baf7bfa50bbd79a63f2f2921909e04e7a1ed514b646289"
+  },
+  {
+    "text": "Aldosterone elevation with suppressed renin levels identifies patients with potential primary aldosteronism.",
+    "tokenCount": 20,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "46035f0d9452c7fe006f3e890ea3ceca45547b607d34dd57013d170cd284af0f"
+  },
+  {
+    "text": "10,13 C Expert opinion and diseaseoriented evidence Patients with a high probability of primary aldosteronism based on clinical presentation and initial biochemical screening (e.",
+    "tokenCount": 33,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5b1b9c46c96b4e515c0cb217e5e5696ebe4b819371316f8019f267ed9fd648fe"
+  },
+  {
+    "text": ", spontaneous hypokalemia with suppressed plasma renin activity and elevated plasma aldosterone concentration) may not require confirmatory testing.",
+    "tokenCount": 27,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5202941640706c2e737dadb084bde00dc81115df2e7e29681960c7410dbc478f"
+  },
+  {
+    "text": "16 C Diseaseoriented case series Once primary aldosteronism has been diagnosed, the next step is to determine if aldosterone production is unilateral or bilateral.",
+    "tokenCount": 33,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "224a09b9f1e059a5c9cb57f7a0f3ad39d9f18f6a6dfc4e72a9896b81151f98e8"
+  },
+  {
+    "text": "This subtyping is accomplished with adrenal computed tomography and adrenal vein sampling.",
+    "tokenCount": 18,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "642dceab3331d04b8f054dc42a99e0fcd2b4e15b6c3cfed22e34179ea80e30a6"
+  },
+  {
+    "text": "13,18,19 C Expert opinion and diseaseoriented studies Adrenalectomy is recommended in cases of unilateral aldosterone production and is superior to medical treatment.",
+    "tokenCount": 32,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "cc89dc66bffc7942a8f8783219d6d08b2848525c1fa7b4686ddfd1fc5e0530b2"
+  },
+  {
+    "text": "Patients treated with adrenalectomy have reduced adverse cardiovascular outcomes and superior qualityoflife measures compared with patients who are managed medically.",
+    "tokenCount": 26,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "5c67f5997e77e0e148c4aa6150253fbe85d08e3d5c24a766690502a8425a0f94"
+  },
+  {
+    "text": "31,32 B Patientoriented outcomes A = consistent, goodquality patientoriented evidence; B = inconsistent or limitedquality patientoriented evidence; C = consensus, diseaseoriented evidence, usual practice, expert opinion, or case series.",
+    "tokenCount": 45,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "422d52ac3e71e896dd8125b4554d90934009fc536f6380e8da2dcf88706cc803"
+  },
+  {
+    "text": "For information about the SORT evidence rating system, go to https:// www.",
+    "tokenCount": 16,
+    "pageStart": 2,
+    "pageEnd": 2,
+    "hash": "08d0c78d7ffd5e1cdc93a70e0603ec5fbd85cd5e9c378b034c5d1460792db51b"
+  },
+  {
+    "text": "org/afp American Family Physician 275 ORAL SALT LOADING TEST For the oral salt loading test, a highsalt diet supplemented with sodium chloride tablets is consumed for three days with a goal sodium intake of 6 g per day.",
+    "tokenCount": 49,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "6c9dfae1e8edd2d1ac42bee3572bf8ab0b657bb345910fae3496a5f0bf4103d7"
+  },
+  {
+    "text": "High salt intake should cause physiologic suppression of the RAAS and a marked decrease in aldosterone levels.",
+    "tokenCount": 22,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "373065b6ad924b9becf8adb2c67be8cf5d21d1a993f376f2930f9ea2e1f6309a"
+  },
+  {
+    "text": "A 24-hour urine collection is performed on the third day.",
+    "tokenCount": 13,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "820fdb89618dcd3b06d9a7a4d7f331349138a2e6edaa05f602d6fb7e596097fe"
+  },
+  {
+    "text": "Persistently elevated 24-hour urine aldosterone levels (more than 12 mcg in 24 hours) are consistent with nonphysiologic production of aldosterone and confirm the diagnosis of primary aldosteronism.",
+    "tokenCount": 46,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "09d48cfc05f39e92e2d17208d063efc727b57176c54761c5a3ba2cc57873f912"
+  },
+  {
+    "text": "The saline infusion test can also confirm pathologic aldosterone production if plasma aldosterone concentration is greater than 10 ng per dL after an infusion of 2 L of normal saline.",
+    "tokenCount": 37,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "03ad7b2f180f38e47a6083169c0771ecc25775e005ec77b43b964f4b8370bf1a"
+  },
+  {
+    "text": "FLUDROCORTISONE TEST The fludrocortisone test involves administration of the synthetic mineralocorticoid fludrocortisone at a dosage of 0.",
+    "tokenCount": 38,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "2f6f24c8cb8ca7ab518295d9b5b9fc76414ea34af5503c9e43461484b489af67"
+  },
+  {
+    "text": "Exogenous mineralocorticoid administration should suppress serum aldosterone levels.",
+    "tokenCount": 16,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "c4e1562c8227ee3fe4625b4d3a6211c94706e11942d5a36094635b8f5dfd1310"
+  },
+  {
+    "text": "A plasma aldosterone concentration of greater than 6 ng per dL on day 4 confirms the diagnosis of primary aldosteronism.",
+    "tokenCount": 28,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "3ea23fb8d5420eb3f539c7260ddc3fb47fb8c81169b08e46a21dac8678441893"
+  },
+  {
+    "text": "Subtyping Once primary aldosteronism has been diagnosed, the next step is to determine if aldosterone production is unilateral or bilateral.",
+    "tokenCount": 30,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "6977147639e9be07f19cc67b5f3d5f979ad359a548954d78e684bb9e927c2798"
+  },
+  {
+    "text": "13,18,19 Unilateral production is typically caused by an aldosteroneproducing adenoma and should be treated surgically, whereas bilateral production is typically from idiopathic hyperplasia and is treated medically.",
+    "tokenCount": 45,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "a61af531513c237f70dbba3f960c929b6ee3f7e95f96cbac9eac56d85bdfb3ce"
+  },
+  {
+    "text": "This differentiation, termed subtyping, is accomplished with adrenal computed tomography (CT) and adrenal vein sampling.",
+    "tokenCount": 25,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "9c0dec54fea971e78cceeb27fdf08ee1fbc44ff0c2045e31f7a4692d37ed81dc"
+  },
+  {
+    "text": "13,18,19 Adrenal CT has three phases: an initial scan without contrast media, a scan at 60 to 75 seconds after contrast media administration, and again at 15 minutes.",
+    "tokenCount": 37,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "4af1a599205937f027144ebf8830aef36a2eecb4e07cd19985f617b5093d9228"
+  },
+  {
+    "text": "By assessing baseline nodule density, as well as contrast media uptake and subsequent washout, benign adenomas can be reliably distinguished from malignant masses.",
+    "tokenCount": 31,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "0a8b9d68670544448903ec372490580dcfabdbfaac39cabec6b5c812f234f74e"
+  },
+  {
+    "text": "20 CT has limited sensitivity for the detection of subcentimeter nodules.",
+    "tokenCount": 15,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "f64595d928da5ede9828c528a48aefff364e4f883d25e84374d3b7540ebd3582"
+  },
+  {
+    "text": "Additionally, CT is unable to distinguish nonfunctioning adenomas from functioning adenomas.",
+    "tokenCount": 19,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "37e451b2c349f6a40434b0d1f88d9346550d5bec23d172bc6ab6500ef10b8046"
+  },
+  {
+    "text": "A systematic review showed an almost 40% rate of discordance between CT and adrenal vein sampling in subtyping patients with primary aldosteronism.",
+    "tokenCount": 32,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "eb1a1cf26d0712887235abaa36db44c02312eb593c6b8e8b7ffc90f16b6f5cbf"
+  },
+  {
+    "text": "21 Therefore, adrenal vein sampling is considered the preferred method of subtyping.",
+    "tokenCount": 17,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "d56dab812efbfae62d0f3d32ae6cadcc256b4ceaed90f8267df78be5015b0520"
+  },
+  {
+    "text": "A systematic review and metaanalysis performed in 2022 found a statistically FIGURE 1 Suggested interpretation of initial case detection testing for primary aldosteronism.",
+    "tokenCount": 31,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "3030c5be6106af7520fae4a44274e3d3c6b0d1db3e7d7cfaf0006aa7217608ea"
+  },
+  {
+    "text": "Note: An aldosteronerenin ratio > 30 is the most common cutoff during initial case detection when plasma aldosterone concentration and plasma renin activity are in conventional units (ng per dL and ng per mL per hour, respectively).",
+    "tokenCount": 49,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "a92820769b162fbb54c503d7026e61ef62b418f92c0ad20558d632a495ccfb6b"
+  },
+  {
+    "text": "Values above the threshold should not be viewed in isolation because the aldosteronerenin ratio may be exaggerated in cases of very low renin levels without significant elevation of aldosterone.",
+    "tokenCount": 37,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "1fe4db42398fe125824d8abd9e3bd387acf8dd93068d18a4898026ba99142fcb"
+  },
+  {
+    "text": "Information from references 10,13, and 15.",
+    "tokenCount": 10,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "66f0a597ca60581de3efc109e5777ad39955dff8ff5027cdb816dd3bd172962b"
+  },
+  {
+    "text": "Aldosteronerenin ratio Plasma renin activity > 1 ng per mL per hour Diagnosis unlikely Plasma renin activity 0.",
+    "tokenCount": 26,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "629ca7383e5d889f1a7727e8f0f8a83d258676c89b39e40ed37b2506e3ba0d59"
+  },
+  {
+    "text": "6 to 1 ng per mL per hour Perform confirmatory testing Plasma renin activity < 0.",
+    "tokenCount": 19,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "009d3aa358afd55306c862b9aadc800ea5e331d6a164b9b9d77118c37e1ffb86"
+  },
+  {
+    "text": "6 ng per mL per hour Plasma aldosterone concentration 20 to 29 ng per dL Plasma aldosterone concentration  30 ng per dL Diagnosis confirmed Plasma aldosterone concentration 11 to 19 ng per dL Perform confirmatory testing Plasma aldosterone concentration  10 ng per dL Diagnosis unlikely Potassium < 3.",
+    "tokenCount": 67,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "22914b194ba3cf3ac8faec4e13039db6dc2d627d37b5d595d6aced632162f0e4"
+  },
+  {
+    "text": "5 mEq per L Diagnosis confirmed Potassium  3.",
+    "tokenCount": 14,
+    "pageStart": 3,
+    "pageEnd": 3,
+    "hash": "2e4028e18e4ef69b8089b58c8184b14e72ce23ff3fbaf8d2e9c2d4b8c14e9806"
+  },
+  {
+    "text": "org/afp Volume 108, Number 3  September 2023 significant higher rate of complete biochemical success when adrenalectomy was guided by adrenal vein sampling compared with adrenalectomy guided by CT alone (odds ratio = 2.",
+    "tokenCount": 47,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "fca2b119fdf73eb84435acf92eb4de0c0d430e6aa81db8a52c7220430700d4bf"
+  },
+  {
+    "text": "18 Adrenal vein sampling is a nuanced procedure.",
+    "tokenCount": 10,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "b04bf0054426f25d7895c798af3cd8aaab1a14c59331fb0a5b29cfaa8d7aefe5"
+  },
+  {
+    "text": "Blood samples are taken from a peripheral vein and the right and left adrenal veins and tested for aldosterone and cortisol levels.",
+    "tokenCount": 26,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "d49b61dfd741038cd3c9b83ce66d3438bab5a415f947e6fb3f19257ae6542961"
+  },
+  {
+    "text": "22 Success rates for adequate sampling range from 30.",
+    "tokenCount": 10,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "4a3aab5d8d707a53a04c7ab797a1e76048e20e4cdf1dc756a19232f80461a086"
+  },
+  {
+    "text": "24 Operator experience at a center that performs at least 12 procedures per year has been shown to be associated with higher sampling adequacy.",
+    "tokenCount": 26,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "2c39df52fb14356958860877ba96dde0c3834a13c41ca571952525971ed1b578"
+  },
+  {
+    "text": "25,26 An experienced and dedicated laboratory is necessary for a successful adrenal vein sampling program, 27 and the results should be interpreted based on expert consensus guidelines.",
+    "tokenCount": 32,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "2e6eb349bd22745e39dee68fa0e3f9a80d554fdce0de11f8c5b84f167a4ce11c"
+  },
+  {
+    "text": "28,29 Treatment UNILATERAL ALDOSTERONE PRODUCTION Adrenalectomy is recommended in cases of unilateral aldosterone production.",
+    "tokenCount": 29,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "76e4a045703a771381071bd1789adc72c5dbfd7c5f4928ed24855179342d33f5"
+  },
+  {
+    "text": "Although hypertension is cured in only approximately onethird of cases, biochemical cure is achieved in 94% of cases.",
+    "tokenCount": 23,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "179d524318b7eb98daf3e4908ff40bdaf86ad1b1357c471ffc16be88340c05c8"
+  },
+  {
+    "text": "30 Compared with medical management, adrenalectomy reduces the rate of composite adverse cardiovascular outcomes by onehalf 31 and is associated with superior quality of life.",
+    "tokenCount": 30,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "f7d2f1f01d63271052396524adb4e1309141755df7dd81651da69dec03e44531"
+  },
+  {
+    "text": "32 BILATERAL ALDOSTERONE PRODUCTION When aldosterone production is bilateral, medical therapy is necessary.",
+    "tokenCount": 25,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "3a2e240b89e7650791f9a2e242f06665b241031045a00261e29ae9743e90a2b0"
+  },
+  {
+    "text": "Mineralocorticoid receptor antagonists are the cornerstone of therapy for patients with primary aldosteronism.",
+    "tokenCount": 23,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "429263048ab6314ad169a3989b7717fc3354153c6c11775c64b155d324f33e37"
+  },
+  {
+    "text": "They are often used concurrently with other antihypertensives.",
+    "tokenCount": 13,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "ebfad5431f0da5e4e35e15905c8cc93a11ab77734125cf950e0b03e9ba51585c"
+  },
+  {
+    "text": "Dietary sodium restriction of less than 1,500 mg per day is recommended.",
+    "tokenCount": 17,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "012e02cf37416c113eec7370539953f07740b72fda6a947e4e7de1039aed5fa5"
+  },
+  {
+    "text": "33 Spironolactone is a nonselective mineralocorticoid receptor antagonist and is the initial medication of choice.",
+    "tokenCount": 26,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "8305a433bba991b133cd411f3f0f0445dd833bdae05baf04b7621146863ee121"
+  },
+  {
+    "text": "5 to 25 mg per day and are increased, as needed, to a maximum dosage of 400 mg per day.",
+    "tokenCount": 23,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "a2ec289d7c3b0de2fba75da9af4345cf55a53a38c5370db5cc4e3584f132dc00"
+  },
+  {
+    "text": "10 Its dosedependent antiandrogenic properties can lead to adverse effects, such as gynecomastia (more than 10%), erectile dysfunction, decreased libido, and irregular menses (1% to 10%).",
+    "tokenCount": 46,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "532ecf3e35491cb5ef80d45749014358cea062fabb3b530861d7ff22788bfa1c"
+  },
+  {
+    "text": "34 If these adverse effects occur, eplerenone, a more selective but less potent and more expensive mineralocorticoid receptor blocker, may be used.",
+    "tokenCount": 33,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "106d1e213070d43afc4cccab9edeefe50481dcd67ba66e53b5de9cf526c0f44c"
+  },
+  {
+    "text": "13,34 Recent observational studies have shown that titrating mineralocorticoid receptor antagonists based on plasma renin concentrations may lead to better outcomes.",
+    "tokenCount": 30,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "f84d7e21d1e6370e812416400ef37b648f004c4b2c07acceb2a89cf69ba6b7bc"
+  },
+  {
+    "text": "35,36 Therefore, future guidelines may include interval measurements of renin as part of the mineralocorticoid receptor antagonist dosing strategy.",
+    "tokenCount": 29,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "b1ea5e184c59bd802efc366ce1b22bcb7bd09834bca654a8404858255ce02dff"
+  },
+  {
+    "text": "36 Data Sources: A PubMed search of clinical trials, metaanalyses, randomized controlled trials, and systematic reviews from 2000 to 2022 was completed using the key terms primary hyperaldosteronism, primary aldosteronism, and hyperaldosteronism.",
+    "tokenCount": 53,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "3e36284d6271aa1298155cc27018d1cc2f2e098b48e91be4abb594191c701cce"
+  },
+  {
+    "text": "We also searched the Cochrane database, Agency for Healthcare Research and Quality (AHRQ), and Essential Evidence Plus using the same terms, but with limited results.",
+    "tokenCount": 33,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "3342a3383ba3939e7a265f4687a4912eb7d872bafe5c819cdc9c0ed9f8bd6fa4"
+  },
+  {
+    "text": "If studies used race and/ or gender as a patient category but did not define how these TABLE 3 Medications to Hold Before Primary Aldosteronism Te s t in g* Medications Hold priority Duration of hold (weeks) Mineralocorticoid receptor antagonists  Mandatory 4 Angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, beta blockers, diuretics, dihydropyridine calcium channel blockers Optional 2 to 4 Alpha blockers, nondihydropyridine calcium channel blockers, vasodilators ContinueNote: Because of interference with the reninangiotensinaldosterone system, certain antihypertensive medications may alter renin and angiotensin levels.",
+    "tokenCount": 144,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "071877e0f8f7ca9da472b30bca3f14419bd0f79f78ee07aa6168d1654bf0f6ad"
+  },
+  {
+    "text": "*Based on the 2016 Endocrine Society Guidelines.",
+    "tokenCount": 10,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "08a1287ca0801627d18dab05653252342c150b66d5f3c1419a637f769ed27c55"
+  },
+  {
+    "text": "Lowdose mineralocorticoid receptor antagonists may not need to be held before aldosteronerenin ratio testing, especially if renin levels are not suppressed.",
+    "tokenCount": 33,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "2139642ddd4ed70ff887ca999826f0e1b778d14eebe63885394ba04da10ec235"
+  },
+  {
+    "text": "TABLE 2 Clinical Criteria for Patients Who Require Case Detection Testing for Primary Aldosteronism Controlled hypertension (any one of the following) Adrenal nodule Atrial fibrillation* Family history of early stroke (i.",
+    "tokenCount": 46,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "0d87121869b6f981ad249d036b8f9d53560fd14863494cc1e5ecef3bb2ffcdc3"
+  },
+  {
+    "text": ", younger than 40 years) Firstdegree relative with primary aldosteronism Hypokalemia Obstructive sleep apnea Resistant hypertension  All patients Note: Criteria are based on the 2016 Endocrine Society Guidelines.",
+    "tokenCount": 46,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "b0be98147cd1d210605d22930366e1fbab4f6ece0c881bf5d65d83c0b499b3f6"
+  },
+  {
+    "text": "*The Endocrine Society does not distinctly list atrial fibrillation as criteria, but it acknowledges that some centers recommend testing given its association with primary aldosteronism.",
+    "tokenCount": 36,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "9f558d9d11230dab2efdcaa3471d1d108c4621152a0ce90fa2d417872f35835d"
+  },
+  {
+    "text": "Resistant hypertension is hypertension that persists despite the concurrent use of three different classes of antihypertensive medications or the use of four antihypertensive medications to achieve adequate blood pressure control.",
+    "tokenCount": 38,
+    "pageStart": 4,
+    "pageEnd": 4,
+    "hash": "bb8b9340ef91229089746fd693f64ac819f663e72bf35aae57500d8fb3d06685"
+  },
+  {
+    "text": "org/afp American Family Physician 277 PRIMARY ALDOSTERONISM categories were assigned, they were excluded.",
+    "tokenCount": 26,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "cbd34e63cc74146f6576859238254334ba24e274780d56b34254b28713f0392f"
+  },
+  {
+    "text": "Physicians may need to exercise caution in applying such guidelines to populations not included (e.",
+    "tokenCount": 18,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "1541bd03e01051e4b445a59aeccd5dc21d9c1d21b9182a41b5c88ad9c6b9c7ee"
+  },
+  {
+    "text": "Search dates: October 2,2022, and May 19,2023.",
+    "tokenCount": 16,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "8eb38ecd3b8c9e3b9cf581ca90ac2a482363d32a55fe81f2e8bc194b83ec4f5b"
+  },
+  {
+    "text": "QUENCER, MD, is an associate professor in the Department of Interventional Radiology at Oregon Health & Science University, Portland.",
+    "tokenCount": 27,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "96abbbe21318abb1dacf05afd8a450d434f23b7d270d4e2a6c23cec8a3410be5"
+  },
+  {
+    "text": "(BRUIN) RUGGE, MD, is an associate professor in the Department of Family Medicine at Oregon Health & Science University.",
+    "tokenCount": 28,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "b79b3117a9f74961b8c4a5bee532d09d5674df6d89c84bcf9654551e52f8b8dd"
+  },
+  {
+    "text": "OLGA SENASHOVA, MD, is an assistant professor of otolaryngology at Oregon Health & Science University.",
+    "tokenCount": 25,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "e7065c2bb3f91a82a986300604be389371d52cf69b7cb8c9cfcb0c7bf7829007"
+  },
+  {
+    "text": "Quencer, MD, Oregon Health & Science University Hospital, 3181 SW Sam Jackson Park Rd.",
+    "tokenCount": 20,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "cca4e47fdb8d08a63516c51201f2e527d7fe79f2cc2e816d928582c4265922f1"
+  },
+  {
+    "text": ", Portland, OR 97239 (kbquencer@ gmail.",
+    "tokenCount": 14,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "18769b12f77cb45919b010b3ff16cfc021db9f7d13a6c6aad758c5cbdc09740a"
+  },
+  {
+    "text": "Reprints are not available from the authors.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2a154572f99421c686b5da2060e472b1442e5ab43a9b2c4e94432c3d4f0e362d"
+  },
+  {
+    "text": "Primary aldosteronism, a new clinical entity.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "da51b7c4a49bbb4da9c3e9fa02b0b694a24a2f632858c82cbb6c49812682afb8"
+  },
+  {
+    "text": "1956; 44(1): 1-15.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2c887311bb905ebd6514f344671e32cf0ecd51fd5b1fdd272b9b3f74cf582fa8"
+  },
+  {
+    "text": "Monticone S, Burrello J, et al.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a8e0ee952ac4177c952f3b5b23662258a397b36992957bbeb1676243167bd0aa"
+  },
+  {
+    "text": "Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice.",
+    "tokenCount": 19,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "5c23cbeed39a1bde071b9b856d5011d0f6b32d29c1db00509f8148e0c9b08cd3"
+  },
+  {
+    "text": "2017; 69(14): 1811-1820.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "21eb7ca6dc0220e8e60904ea84a78a7c39ff70068ef400e5952b431f950608dd"
+  },
+  {
+    "text": "Brown JM, Siddiqui M, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "b73a532e514fbec8b7d57a9baf1b5f039f36d09ac860da33d2d4f102970276f8"
+  },
+  {
+    "text": "The unrecognized prevalence of primary aldosteronism: a crosssectional study.",
+    "tokenCount": 17,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "1b4f2277ee6fae03fbdea34c0a6744160fda4b86568b0c242796b26b7e7399e2"
+  },
+  {
+    "text": "2020; 173(1): 10-20.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2dfb3820ef6e3c4b955c9b1d2f1c97d2fdee1bfc03aaf6c01d125e96fd07672e"
+  },
+  {
+    "text": "Cohen JB, Cohen DL, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6144fd0ca6c6e8c0953047dff86c518979ae5f8c788b66a60e5009436f0406ae"
+  },
+  {
+    "text": "Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.",
+    "tokenCount": 20,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "104dc023a06cb3744bef71bd3067fba1e538e19ff06accbd1e6f04abca84cdee"
+  },
+  {
+    "text": "2021; 174(3): 289-297.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2afeb7910185d59207424226d7e33dbe97314cafa8c3a8c4590b545f17096f50"
+  },
+  {
+    "text": "Jaffe G, Gray Z, et al.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "19dd74b384eff915f22db7e0f86e14dcc445234b9c97bee9fd6fc9ebce49d6c1"
+  },
+  {
+    "text": "Screening rates for primary aldosteronism in resistant hypertension: a cohort study.",
+    "tokenCount": 18,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "109cb1f86f4ea87723946eb4f980e7b75a81a717a9de2d2db058452ef84a4339"
+  },
+  {
+    "text": "2020; 75(3): 650-659.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "272ca7c20cc0b59ea2163107c4c0f38692496b1ba4620961020b1ee2516db1b2"
+  },
+  {
+    "text": "Lim YY, Shen J, et al.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "421a538aabd8d1c88e801042c70f6720be30c7ba4fea78c9cc833c72f4f727dc"
+  },
+  {
+    "text": "Current pattern of primary aldosteronism diagnosis: delayed and complicated.",
+    "tokenCount": 15,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "4dbcbdd6f92bd191dc4bfb72853ac96dcb1b754046f1baccc1c21e22214e6709"
+  },
+  {
+    "text": "2018; 47(10): 712-718.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2f52d11bb05414476d204b9acca6b0beeec970475f942fec2cc1821b00437103"
+  },
+  {
+    "text": "Curr Opin Endocrinol Diabetes Obes .",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d6382ca6e749fe5ebebcc8af5e17597aa0cd3ba5326a36ec07440279a5e015d1"
+  },
+  {
+    "text": "2010; 17(3): 199-204.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "697acf35f484832036ba11ffa6342f65dedf5904d2a9ad05d3b0502856b30001"
+  },
+  {
+    "text": "Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis.",
+    "tokenCount": 15,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "5129aadbb10f878f8d28ac4566b88aa2801de315b602b7eb20b31fd1f36247dc"
+  },
+  {
+    "text": "2013; 9(8): 459-469.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "13f15e17a839970fa89bf976bf31d2f0c3984dde2d5159271f0052268444dce0"
+  },
+  {
+    "text": "Rosa J, Somlov Z, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6c819f174349efab043ef5babb4f19c161a311321e3d77e6d9861cc95083c0db"
+  },
+  {
+    "text": "Peripheral arterial stiffness in primary aldosteronism.",
+    "tokenCount": 14,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "ec089f6088c2a8df17b0c874bbafd1e5c711b4357f3e1b8945533e23be9381f3"
+  },
+  {
+    "text": "2012; 61(5): 461-468.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2b764d0c62202554b047a229d1819d8eb29abff3caffdd4c31a4d95dbf341b76"
+  },
+  {
+    "text": "Diagnosis and treatment of primary aldosteronism: practical clinical perspectives.",
+    "tokenCount": 17,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d8d9397a2802ec4124fcf1a68507f49007c5f9f9982b9c88adb9022a45377bec"
+  },
+  {
+    "text": "2019; 285(2): 126-148.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2940e16477e22b95848bcb30f06076873f151f01aaf22aa0323622d19a44a8d4"
+  },
+  {
+    "text": "Monticone S, DAscenzo F, et al.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "60fb68b3c60679715207676079d2cc7b4365674279124c37920eac8a37134ea1"
+  },
+  {
+    "text": "Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and metaanalysis.",
+    "tokenCount": 26,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6317ce0a1c256588835e181be933da9048c8e27c9f57f27db4a46aba9f728e70"
+  },
+  {
+    "text": "2018; 6(1): 41-50.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "99d99d1dce2cf74373a6a8679e339ff2c7fb08b63986eeaa4763b34ff3ae0ae0"
+  },
+  {
+    "text": "Monticone S, Sconfienza E, et al.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "f85d13e5476ec723ee063347f4f389464c29e6cff8fb8ed05ca487ad8285547f"
+  },
+  {
+    "text": "Renal damage in primary aldosteronism: a systematic review and metaanalysis.",
+    "tokenCount": 18,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "cab40d04ded974033dacdfd14dbb81617b9ca9a7b64d7c0a6559ab3a7dcfe070"
+  },
+  {
+    "text": "2020; 38(1): 3-12 .",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "90f0bca1ac91d3f36752d28dc73a2eaf3b96acb24264bd6e49024408cc492803"
+  },
+  {
+    "text": "Funder JW, Carey RM, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a71a244a90b5a325a3a7a5f2c5c42b0c7f0b4fcaec183e163c7332e5ed540043"
+  },
+  {
+    "text": "The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline.",
+    "tokenCount": 26,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "11de25db79548c7dc3db2119eb70b04209814f8dea46b0f152bcf008e12f7466"
+  },
+  {
+    "text": "2016; 101(5): 1889-1916.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "bb144d6fee04bfb7702294b7573ff1a2b10062a09a6dbaacd4c0472912c2358e"
+  },
+  {
+    "text": "Rossi GP, Bernini G, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "40753b8fde6eb366e11e727e7276d6c9d7715c3d561ac55579a5d30742d6f1ec"
+  },
+  {
+    "text": "A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.",
+    "tokenCount": 21,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "996982b03af08f6557d302a7709e184ac0118542d562a79eef32ad2be49ee07e"
+  },
+  {
+    "text": "2006; 48(11): 2293-2300.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c288d13152b631a379e8b506902875d79fdadd214da8ea47a782e5692d448c55"
+  },
+  {
+    "text": "Kawashima J, Araki E, et al.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "9319df1d10803b8d0cc7927bd92c918721d57919ebf7863aebe381b7e2bffa4d"
+  },
+  {
+    "text": "Baseline plasma aldosterone level and renin activity allowing omission of confirmatory testing in primary aldosteronism.",
+    "tokenCount": 25,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "ed2825a69c8a52ed25c42b1d81810df720bd0fbd9bf45da66de761a6e31ef02c"
+  },
+  {
+    "text": "2020; 105(5): dgaa117.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "4446a62ca7cb4fbbd4596ab794c82526c09262c92e3f8afac32ba362584a41e8"
+  },
+  {
+    "text": "Umakoshi H, Sakamoto R, et al.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "e34e29da70b13d5995200c6478e0e3a059348843d27a77a89ce5ae9efc7ea12d"
+  },
+  {
+    "text": "Role of aldosterone and potassium levels in sparing confirmatory tests in primary aldosteronism.",
+    "tokenCount": 21,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c6e2b65167360e4a6b0ffe84cd1d77834429bdbfcb5b0a2075ce011527ccecc4"
+  },
+  {
+    "text": "2020; 105(4): dgz148.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "567338c72bee7a73fdcf4eae68f65ae60acffe2663608241d58e71d965385de9"
+  },
+  {
+    "text": "Wu S, Yang J, et al.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "5e7a5ce58cdb921d0db111b1c2bcf8f3708291ae0274757e7e08747433be6ba9"
+  },
+  {
+    "text": "Confirmatory tests for the diagnosis of primary aldosteronism: a systematic review and metaanalysis.",
+    "tokenCount": 22,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d20908c65fff97984e6a96e51a5e8c092e26166dde9d5605d48d7003c1f1680c"
+  },
+  {
+    "text": "Clin Endocrinol (Oxf) .",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "ad088ec201aea1b7dbc39832b4400541eb19b4849f9ade068b9b6f7576a2b951"
+  },
+  {
+    "text": "2019; 90(5): 641-648.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "0614cd1b1b9a03839f9f6d984ef9695f9d7a5190ca2d35fa5d66d8c87847f1ac"
+  },
+  {
+    "text": "Prognosis of adrenalectomy guided by computed tomography versus adrenal vein sampling in patients with primary aldosteronism: a systematic review and metaanalysis.",
+    "tokenCount": 34,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "22ced09bf8592c44a53649040223e7d3342cc82d3093abb9926b7a749be8e21e"
+  },
+  {
+    "text": "J Clin Hypertens (Greenwich) .",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "678c82abc18bcf26f50be57b97fb170ce30cc36e82395e279d7c266ac7592407"
+  },
+  {
+    "text": "2022; 24(2): 106-115.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "659a89e14a4f824565eb6ac36bb387155c28e78ad8c9605c18bb8891a84dc0b8"
+  },
+  {
+    "text": "Lim V, Guo Q, et al.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "b7d274ed97021924f3b0c27626bf9612409db57e7bb05a65fd251a7320750c4a"
+  },
+  {
+    "text": "Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism.",
+    "tokenCount": 24,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "18df92109e294d18757f92ab8d1d6377efa169f0d6ec621f90def155e0f68ac2"
+  },
+  {
+    "text": "2014; 99(8): 2712-2719.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6efe41b75260f238a39a29e8ab55052c5fc1477d3b86836328758839237ba6e8"
+  },
+  {
+    "text": "Pea CS, Boland GW, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6a71a32f62648ecdf9635ca7578f42f46c36bb0bb7259c0a45f7de8de0c23bc5"
+  },
+  {
+    "text": "Characterization of indeterminate (lipidpoor) adrenal masses: use of washout characteristics at contrastenhanced CT.",
+    "tokenCount": 26,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "68656f7e5630a2ad325b4da2746e57f0b80b8cb122861aeb75e8ba4319a133cd"
+  },
+  {
+    "text": "2000; 217(3): 798-802.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "2cbdef7d5901d3d18039d91abea8b0577bf0fd1da626b07497a9d986f8002488"
+  },
+  {
+    "text": "Kempers MJE, Lenders JWM, et al.",
+    "tokenCount": 14,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "73b7c6330a484e04d11819a7cb7c975903e582163f5f77a9ca5fbe168d08db58"
+  },
+  {
+    "text": "Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism.",
+    "tokenCount": 23,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "79c389242dc611a97e2476b20b6d231175b4e624b36822fd38ec9c36e88f4c3a"
+  },
+  {
+    "text": "2009; 151(5): 329-337.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "077c82a36629164962d73dafcaaec2875222b30f319cd7232e5feeff526bcfe8"
+  },
+  {
+    "text": "Monroe EJ, Carney BW, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6a2886159cede572d87de2d453263d891c1163d0a289efe119892560bc5a1f0e"
+  },
+  {
+    "text": "2017; 37(4): 1246-1267.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d2508037d66d1477b6e8bb18f0af86ef14f07e983188896511cf2df8e6a08497"
+  },
+  {
+    "text": "Vonend O, Ockenfels N, et al.",
+    "tokenCount": 14,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "f3cfc3ecc1b711d2401c024e89b428d9651b14960641fac2ea2c15faca27db24"
+  },
+  {
+    "text": "Adrenal venous sampling: evaluation of the German Conns registry.",
+    "tokenCount": 15,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a113f9ee9c54e569548dd08f9963d30ee3c722325da88c1d66012ffd7606873c"
+  },
+  {
+    "text": "2011; 57(5): 990-995.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a5385136a93cfdb2879b9259a4ebb6719184567ac538000becc15e35ce8845fe"
+  },
+  {
+    "text": "Ota H, Seiji K, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "72a72851744606370d1ad1d6b0498cbd5aee508cac8f4ed0edf39ec1d67f0ef0"
+  },
+  {
+    "text": "Dynamic multidetector CT and noncontrastenhanced MR for right adrenal vein imaging: comparison with catheter venography in adrenal venous sampling.",
+    "tokenCount": 33,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "1950968f737fc1abdb6a4cf204402255b38d33a584c15907aa076c8bbbf166e0"
+  },
+  {
+    "text": "2016; 26(3): 622-630.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "3b94ed7d73d92a9cfec97e2808cc8ed803a480194375818d101be5ff1447c1ca"
+  },
+  {
+    "text": "Tan MO, Puar THK, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a396766d0144ccb5dcb406f56edf74089760a93af43522897236ddbe0d0c81bb"
+  },
+  {
+    "text": "Improved adrenal vein sampling from a dedicated programme: experience of a lowvolume single centre in Singapore.",
+    "tokenCount": 20,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d785cf496c75e2494dec2e034442dc77e7b066901225106f665cc668e2db6a02"
+  },
+  {
+    "text": "2022; 63(2): 111-116.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "154d9bd5f5f438301209a329c59b0fffc9fa237ab75de74a4ed06dea6d10237b"
+  },
+  {
+    "text": "Jakobsson H, Farmaki K, et al.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "08b0bcd192ac67846cd2d760b73fea7733e9637ab3539b89bcb3f1e00e7116af"
+  },
+  {
+    "text": "Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures.",
+    "tokenCount": 21,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a88510f691e07276bd536b1ec371b024433daaf88e71610e8f88d1a38722f37c"
+  },
+  {
+    "text": "2018; 24(2): 89-93.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "4db081b04468db0fbc75c7b15fc5b25488fee402ac596b0abf08b6a592e6b4da"
+  },
+  {
+    "text": "Adrenal venous sampling for primary aldosteronism: laboratory medicine best practice.",
+    "tokenCount": 19,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "d60d1148b01defa43ed40578158bb5757b3e9e89ed3a0817c7cec10bf1a46797"
+  },
+  {
+    "text": "2017; 70(11): 911-916.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "3da7899ad5c2d10b3dc009a63a39ea2c17801bacd9ef5ada3773c4fc0b8c600d"
+  },
+  {
+    "text": "Kline GA, Harvey A, et al.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "9c49dc167ce757dd2dd98a793b5eafc57b4128ffaf19b471751db90fbeea90af"
+  },
+  {
+    "text": "Adrenal vein sampling may not be a goldstandard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used.",
+    "tokenCount": 31,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "68ed0461c41eaa83e7883227b0068311359fe5697e00fd20682339dfb279f119"
+  },
+  {
+    "text": "2008; 40(4): 1035-1043.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "b2f2aff542a90a91dfed29d79e4ba62d7211d18922780bf3eaa758bf13abaa06"
+  },
+  {
+    "text": "Rossi GP, Auchus RJ, et al.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "73fc55a8c0df396a61267db46ba2cab1348193e1b06e3b0eca012a3f7a050ae5"
+  },
+  {
+    "text": "An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism.",
+    "tokenCount": 24,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c0977550d815d645feef70b241576b8807d5d3718cb565a92e6a189a0ad0fa1e"
+  },
+  {
+    "text": "2014; 63(1): 151-160.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c15a9d4ac832e0b03e932723ad6c89aed10fa47bc7d36c54387322f594f693de"
+  },
+  {
+    "text": "Williams TA, Lenders JWM, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "750f17ffde70498b1ddb6000ff9cb0fe4733c2b9cb4a13326a3a5a441ed13591"
+  },
+  {
+    "text": "; Primary Aldosteronism Surgery Outcome (PASO) Investigators.",
+    "tokenCount": 16,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "b66b65b1a9231f890d1f78ff726c3b83b67cc816c2c30febffc0ec0acd62087e"
+  },
+  {
+    "text": "Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort.",
+    "tokenCount": 31,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "ab317bb1509685ef4f087ae5f89ed40b386369f4ef74887a8580c908bbed16c2"
+  },
+  {
+    "text": "2017; 5(9): 689-699.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "6a8b378178dba8bd25c56c6028f55a85410392dae2ba36a5e8af95d3b2988a33"
+  },
+  {
+    "text": "Huang WC, Chen YY, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "3259b6354f1d042e05ab9550655a337f680ee2c15fa1fd5f52fe8cd3cf431c21"
+  },
+  {
+    "text": "Composite cardiovascular outcomes in patients with primary aldosteronism undergoing medical versus surgical treatment: a metaanalysis.",
+    "tokenCount": 24,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "937ab0232573f885ef5eaaf2c395d62d968717ea4679e0fc492731635c1c859a"
+  },
+  {
+    "text": "Front Endocrinol (Lausanne) .",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "ba90e4b396954219fab4329eaade4f0a567f8c25a841aac1561656bc26eb5b18"
+  },
+  {
+    "text": "Velema M, Dekkers T, et al.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "ba5c3e10788fd1fc74b5f2319361d791ee61a1fbe32668fbef9ede3c5f8ffb70"
+  },
+  {
+    "text": "Quality of life in primary aldosteronism: a comparative effectiveness study of adrenalectomy and medical treatment.",
+    "tokenCount": 23,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "71d78ca4086aaacca9cea0e6a732d51fa8cef9002368643b4f7a0b015c731b22"
+  },
+  {
+    "text": "2018; 103(1): 16-24.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "01bf5fe10f04453cbf3f7b3d7e90922cbab34965db4dcfdb3b6cf501f513849e"
+  },
+  {
+    "text": "Vaidya A, Hundemer GL, et al.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "821b7b4c3c24eee29a90c0f3cf171e3d212242643249cedf15b8a704e28bfb27"
+  },
+  {
+    "text": "Primary aldosteronism: stateoftheart review.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "679c2e956033b9bd80815dd8e8e57d8730b236aaeb72b15aee16d65b4a1bbe29"
+  },
+  {
+    "text": "2022; 35(12): 967-988.",
+    "tokenCount": 13,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "13ec994a1d89d2867d94badf5b0efb020608c072c111bd58f83e87138e3524f7"
+  },
+  {
+    "text": "Lainscak M, Pelliccia F, et al.",
+    "tokenCount": 14,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "13c3b07251024cc4ad4e8d49600023236d1b6c6a4742745e3288c667df8d4f79"
+  },
+  {
+    "text": "Safety profile of mineralocorticoid receptor antagonists: spironolactone and eplerenone.",
+    "tokenCount": 22,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c295e9622b4a3aad17ceb838f13263aeea35a01344c6bb2fe07f0da918ed7935"
+  },
+  {
+    "text": "Khler A, Sarkis AL, et al.",
+    "tokenCount": 11,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "a42de8bacc281115e8fe119715294cb26aa57c4ef198cd434c0f24e36dfacdc8"
+  },
+  {
+    "text": "Renin, a marker for left ventricular hypertrophy, in primary aldosteronism: a cohort study.",
+    "tokenCount": 25,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "63cc613aa001b54f2411473f611faecf2c8819f8d0332524b53469796925c2e7"
+  },
+  {
+    "text": "2021; 185(5): 663-672.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "193ec58ffb2ef0474d1f0f9fb14abf7fe3cf5ec9045061ef609bafa60d62dd41"
+  },
+  {
+    "text": "Hundemer GL, Curhan GC, et al.",
+    "tokenCount": 12,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "4b695a50740f578ef05852d3dfabcd5451a186cc2bd49e5d3e98818344182ddd"
+  },
+  {
+    "text": "Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study.",
+    "tokenCount": 22,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "4b1bca054b7241bdec043b65c17fc06f40fb9c69f450c485aea83cc6458e9712"
+  },
+  {
+    "text": "2018; 6(1): 51-59.",
+    "tokenCount": 10,
+    "pageStart": 5,
+    "pageEnd": 5,
+    "hash": "c250b1df116d37979fe7172006e2c213f7edebb5dc22e601bbbc01c2063674a2"
+  }
+]