Delete Capstone Course Adrenal Nodule information

Capstone Course Adrenal Nodule information/Adrenal Incidentaloma Practice Guidelines.pdf_semantic.json

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-    "text": "1542 Clinical Pr actice From the Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.",
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-    "text": "Kebebew at the Division of General Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr.",
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-    "text": ", H3642, Stanford, CA 94305-2200, or at kebebew@ stanford .",
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-    "text": "1056/NEJMcp2031112 Copyright  2021 Massachusetts Medical Society.",
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-    "text": "A 42-yearold woman has been in a motor vehicle accident in which her seat belt tightened.",
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-    "text": "She has upper abdominal pain and is evaluated with computed tomography (CT).",
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-    "text": "This imaging shows no evidence of intraabdominal trauma but reveals a wellcircumscribed and homogeneous left adrenal mass that is 3.",
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-    "text": "The mass has an attenuation value of 7 Hounsf ield units on unenhanced CT.",
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-    "text": "The patients history is remarkable for obesity and newly diagnosed mild hypertension.",
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-    "text": "On physical examination, the blood pressure is 142/90 mm Hg.",
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-    "text": "There is sternal and upper abdominal bruising but no striae, moon facies, or fat accumulation over the dorsocervical spine (buffalo hump).",
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-    "text": "How should this patient be further evaluated and treated?",
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-    "text": "The Clinical Problem A drenal incidentaloma is defined as a clinically unapparent adrenal lesion (1 cm in diameter) that is detected on imaging performed for indications other than evaluation for adrenal disease.",
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-    "text": "1 This definition excludes patients who are undergoing screening and surveillance because of hereditary syndromes or those with known extraadrenal cancer who are undergoing imaging for staging or during followup after treatment.",
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-    "text": "Among adults, the prevalence of adrenal incidentaloma has been reported to be 1 to 6%, 2,3 and the prevalence has increased with the growing use of and technological advances in imaging and with the aging of the population.",
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-    "text": "4,5 The prevalence is higher among older adults, with a peak (7%) in the fifth to seventh decades.",
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-    "text": "3 Most adrenal incidentalomas are nonfunctioning benign tumors; 75% are nonfunctioning cortical adenomas.",
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-    "text": "6-9 However, there are important clinical consequences in a subset of these masses.",
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-    "text": "For example, approximately 14% of adrenal incidentalomas are functional tumors that secrete excess cortisol, aldosterone, or (rarely) both.",
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-    "text": "Other masses with clinical significance are pheochromocytomas (approximately 7%) and primary adrenal cancers or metastases to the adrenal glands (approximately 4%).",
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-    "text": "6-9 When an adrenal mass is incidentally identified, the key clinical questions are whether it is functioning and whether it is malignant.",
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-    "text": "These determinations are guided by clinical and radiographic features and biochemical assessments.",
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-    "text": "Str ategies and Evidence In the absence of randomized, controlled trials in which various approaches to evaluation are compared, the workup is guided by data from prospective and retrospective observational studies.",
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-    "text": "A careful history taking and physical examination Caren G.",
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-    "text": ", Editor Adrenal Incidentaloma Electron Kebebew, M.",
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-    "text": "This Journal feature begins with a case vignette highlighting a common clinical problem.",
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-    "text": "Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist.",
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-    "text": "An audio version of this article is available at NEJM.",
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-    "text": "All rights reserved, including those for text and data mining, AI training, and similar technologies.",
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-    "text": "Clinical Pr actice 1543 focusing on signs and symptoms that may be associated with hormonal hypersecretion or cancer are essential (Fig.",
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-    "text": "1, and Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.",
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-    "text": "Hormonal Evaluation Mild Autonomous Cortisol Excess Abnormal cortisol secretion that is independent of normal hypothalamicpituitary control in the absence of overt clinical signs of Cushings syndrome is called mild autonomous cortisol excess (also known as subclinical Cushings syndrome).",
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-    "text": "A careful history taking and physical examination should focus on determining whether the patient has had recent weight gain or has a history of easy bruising, general weakness, poor wound healing, or decreases in memory and cognitive function.",
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-    "text": "The patient should also be evaluated for the presence of central obesity, purple striae, facial rounding and plethora, supraclavicular and dorsocervical fat pads, acne, and hirsutism.",
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-    "text": "Mild autonomous cortisol excess, the most common functional disorder detected in patients with adrenal incidentaloma, occurs in approximately 10% of such patients (range, 1 to 29), depending on the diagnostic criteria used and the population studied. 3,6 ,7,9 Patients with mild autonomous cortisol excess have a higher incidence of coexisting conditions such as hypertension, obesity, glucose intolerance or type 2 diabetes mellitus, dyslipidemia, and osteopenia or osteoporosis than patients with nonfunctioning adrenal tumors.",
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-    "text": "10 An overnight dexamethasone (1 mg) suppression test should be performed in all patients with adrenal incidentaloma (Table 1).",
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-    "text": "The most appropriate cutoff value for the morning serum cortisol level to make a diagnosis of mild autonomous cortisol excess is controversial.",
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-    "text": "8 g per deciliter (>50 nmol per liter) has high sensitivity (95 to 100%) but low specificity (60 to 80%), whereas a level of more than 5. 0 g per deciliter (>138 nmol per liter) has lower sensitivity (86%) but higher specificity (92 to 97%).",
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-    "text": "3,7,11-1 3 Additional findings on biochemical tests (e.",
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-    "text": ", a low corticotropin level, an elevated 24-hour urinary cortisol level, a high latenight salivary cortisol level, and a low dehydroepiandrosterone sulfate level) may help to confirm the diagnosis and magnitude of cortisol excess (Table 1).",
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-    "text": "14 In a metaanalysis assessing outcomes in 4121 patients with adrenal incidentalomas that were either nonfunctioning or were causing mild autonomous cortisol excess, the risk of progression to overt Cushings syndrome was low (<0.",
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-    "text": "1%) in both groups during a mean followup of 50.",
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-    "text": "15 Furthermore, mild autonomous cortisol excess developed in only 4.",
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-    "text": "3% of the patients with nonfunctioning tumors, and fewer than 0.",
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-    "text": "1% of the patients with mild autonomous cortisol excess had spontaneous resolution during followup.",
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-    "text": "The prevalence of type 2 diabetes mellitus, hypertension, obesity, dyslipidemia, Key Clinical Points Adrenal Incidentaloma  All patients with an adrenal mass that is discovered during diagnostic testing for another condition (an incidentaloma) should undergo biochemical testing to detect pheochromocytoma and excess cortisol secretion, and those who also have high blood pressure should undergo biochemical testing to detect primary hyperaldosteronism.",
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-    "text": "Patients with pheochromocytoma should undergo adrenalectomy after adequate presurgical alphablockade and betablockade, if necessary.",
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-    "text": "Patients with mild autonomous cortisol excess and primary hyperaldosteronism may benefit from adrenalectomy, but treatment should be individualized.",
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-    "text": "Nonfunctioning adrenal tumors that have an attenuation of 10 Hounsfield units or less on computed tomographic (CT) evaluation and that are smaller than 4 cm in greatest diameter generally do not warrant intervention or longterm followup.",
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-    "text": "All other adrenal incidentalomas with indeterminate features on imaging may warrant additional imaging with contrastenhanced CT, magnetic resonance imaging with chemicalshift analysis, positronemission tomographyCT with 18 Ffluorodeoxyglucose, or all of these tests.",
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-    "text": "The management of these masses should be individualized and should involve a multidisciplinary team consisting of an endocrinologist, an endocrine surgeon, and a radiologist.",
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-    "text": "Biochemical Evaluation in Patients with Adrenal Incidentaloma.",
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-    "text": "* Clinical Diagnosis Screening Test Additional or Confirmatory Test Common Causes of False Positive or False Negative Findings Special Considerations Mild autonomous cortisol excess Overnight dexamethasone (1 mg) suppression test; an abnormal result is a serum cortisol level >1.",
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-    "text": "8 g per deciliter (50 nmol per liter) with confirmation of serum dexamethasone level (to ensure adherence); a higher serum cortisol cutoff level (e.",
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-    "text": ", 35 g per deciliter) can be used to reduce the risk of a false positive Measurement of levels of morning serum corticotropin and cortisol levels, 24-hr urinary cortisol, latenight salivary cortisol, midnight serum cortisol, and DHEAS False positives may occur in patients receiving medications that accelerate hepatic metabolism of dexamethasone and with nonadherence to dexamethasone Consider a pseudoCushings syndrome state due to diabetes, obesity, pregnancy, alcoholism, psychiatric disorders, or stress Pheochromocytoma Measurement of levels of plasmafree metanephrines or 24-hr urinary fractionated metanephrines Not applicable False positives may occur in patients with stress and illness warranting hospitalization; with medications that increase levels of endogenous catecholamines; with excessive caffeine; and with recreational drug use (e.",
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-    "text": ", amphetamines) Biochemical testing may not be necessary if the adrenal mass has CT attenuation of 10 Hounsfield units; genetic testing for inherited syndrome should be performed, regardless of family history, if screening test is positive Primary hyperaldosteronism Measurement of midmorning plasma aldosterone concentration and plasma renin activity; a ratio of plasma aldosterone concentration to plasma renin activity >20 confirms diagnosis If the ratio of plasma aldosterone concentration to plasma renin activity <20, confirmatory testing includes 24-hr urinary aldosterone excretion test with patient receiving highsodium diet, aldosterone suppression test, and testing with saline infusion while patient is sitting False positives can be caused by betablockers, methyldopa, clonidine, nonsteroidal antiinflammatory drugs, and oral contraceptives and estrogen; false negatives can be caused by angiotensinconvertingenzyme inhibitors, angiotensin II receptor blockers, and potassiumsparing diuretics (e.",
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-    "text": ", spironolactone, eplerenone, and amiloride) If patient is a candidate for adrenalectomy and >35 yr of age, adrenal venous sampling is recommended to confirm lateralization of aldosterone to the side of the adrenal mass (some patients have bilateral aldosterone hypersecretion, or the contralateral adrenal gland may be the source of excess aldosterone and the tumor detected is nonfunctioning) * Reference ranges for specific assays based on age and sex should be used and may differ from the ranges shown here.",
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-    "text": "DHEAS denotes dehydroepiandrosterone sulfate.",
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-    "text": "Additional laboratory tests may include measurement of plasma chromogranin A levels, 24-hour urinary 3-methoxytyramine levels, or both, especially when a malignant pheochromocytoma is suspected because of the presence of potential metastatic disease sites or local invasion.",
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-    "text": "Clinical Pr actice Primary Hyperaldosteronism Among patients with adrenal incidentaloma, primary hyperaldosteronism is less common than mild autonomous cortisol excess and pheochromocytoma; primary hyperaldosteronism accounts for 1.",
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-    "text": "9 However, any patient with adrenal incidentaloma and hypertension or hypokalemia should be screened for primary hyperaldosteronism with measurement of the midmorning plasma aldosterone concentration and plasma renin activity; patients should not be taking medications that could cause false positive or false negative results (Table 1).",
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-    "text": "31 Although studies have used various cutoff values to identify hyperaldosteronism, a ratio of the plasma aldosterone concentration to plasma renin activity that is higher than 20 is considered to be a reliable indicator of the diagnosis; if the ratio is high but below this level, confirmatory testing is recommended (Table 1).",
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-    "text": "31,32 Once the diagnosis is established, patientspecific factors guide decisions regarding medical versus surgical therapy (Fig.",
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-    "text": "Additional Hormonal Secretion It is extremely rare for patients with adrenal incidentaloma to have sex hormone (estrogen or testosterone)secreting tumors without appreciable clinical manifestations.",
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-    "text": "In women, excess testosterone is associated with features of virilization such as facial hair growth, acne, and deepening of the voice, and excess estrogen is associated with irregular uterine bleeding and breast tenderness.",
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-    "text": "In men, estrogensecreting tumors can cause gynecomastia, testicular atrophy, and decreased libido.",
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-    "text": "Assessment for Cancer An adrenal incidentaloma may be a primary malignant tumor that has arisen from the adrenal cortex (adrenocortical carcinoma) or medulla (pheochromocytoma), or, rarely, a metastatic tumor.",
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-    "text": "Adrenocortical carcinoma, which accounts for 1.",
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-    "text": "0% of adrenal incidentalomas, 9 depending on the study population, may secrete excess hormones or be nonfunctioning.",
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-    "text": "Up to 21% of adrenal incidentalomas in patients with a history of or known current primary cancer indicate adrenal metastasis.",
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-    "text": "9,33 Cancers that are most likely to spread to the adrenal glands are lung cancer, gastrointestinal cancer, melanoma, and renalcell carcinoma.",
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-    "text": "33 Tumor size and imaging features are key to determining the likelihood of cancer and guiding treatment (Table 2 and Figs.",
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-    "text": "Tumor Size Although many studies of the risks of cancer associated with tumor size are limited by small samples, retrospective design, and selection bias, data consistently support associations between tumors that are larger than 4 cm in greatest diameter and an increased risk of cancer among patients with a unilateral adrenal mass (Table 2).",
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-    "text": "35,36 The risk of adrenocortical carcinoma is less than 2% among patients with tumors smaller than 4 cm in diameter, 6% among those with tumors between 4 cm and 6 cm in diameter, and 25% or higher among those with tumors that are at least 6 cm in diameter.",
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-    "text": "35 However, patient age is an important factor in estimating cancer risk; because benign incidentalomas are uncommon in patients younger than 40 years of age, cancer is a concern even with smaller tumors (<4 cm in diameter) in this age group.",
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-    "text": "It is important to measure the adrenal tumor in three dimensions (the greatest length, width, and height) because twodimensional (crosssectional) measurements often underestimate size.",
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-    "text": "Imaging Features Suggestive of Cancer On CT imaging, features other than tumor size can help to differentiate benign from malignant adrenal incidentalomas, although the ultimate diagnosis is based on histologic findings or clinical followup.",
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-    "text": "34,37 Irregular tumor margins, heterogeneity, necrosis, vascularity, and calcification are features that arouse suspicion for cancer (Table 2).",
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-    "text": "An attenuation of 10 Hounsfield units or less on unenhanced CT is consistent with a benign lesion; in a series of 1161 adrenal tumors with an attenuation of 10 Hounsfield units or less, no malignant tumors were observed.",
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-    "text": "38 In patients who have incidentalomas with an attenuation of more than 10 Hounsfield units, followup imaging may include contrastenhanced CT (to measure the percentage of washout of contrast medium at various times), MRI with chemicalshift analysis, or positronemission tomography (PET)CT with 18 Ff luorodeoxyglucose ( 18 FFDG).",
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-    "text": "On contrastenhanced CT, adenomas commonly enhance more rapidly and have faster washout of intravenous contrast medium when .",
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-    "text": "Clinical Pr actice measured at 60 to 90 seconds (early enhancement) and at 10 to 15 minutes (delayed enhancement) after the administration of contrast medium than adrenocortical carcinomas.",
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-    "text": "Absolute washout is defined as the attenuation value in Hounsfield units on early enhanced CT minus Hounsfield units on delayed CT, divided by Hounsfield units on early enhanced CT minus Hounsfield units on unenhanced CT, multiplied by 100%, and relative washout is defined as Hounsfield units on early enhanced CT minus Hounsfield units on delayed CT, divided by Hounsfield units on enhanced CT, multiplied by 100%.",
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-    "text": "Absolute washout of more than 60% of the contrast medium and relative washout of more than 40% of the contrast medium are suggestive of an adenoma, but the sensitivities and specificities of these cutoff values vary across studies owing to variations in technique and timing of measurement of washout.",
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-    "text": "34 MRI with chemicalshift analysis, which assesses qualitative loss of signal intensity, quantitative loss of signal intensity, or both between inphase and outofphase imaging, is especially useful to avoid radiation exposure in pregnant women and children and in patients who are allergic to iodinated contrast medium.",
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-    "text": "In a systematic review, qualitative (visual) analysis of the adrenal signalintensity index and quantitative assessment of the adrenaltospleen ratio (i.",
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-    "text": ", the signal intensity of the adrenal mass divided by the signal intensity of the spleen) both had high accuracy (pooled sensitivities and specificities, 94% and 95%, respectively) for identifying adenomas.",
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-    "text": "37 In a metaanalysis of 29 studies, findings on 18 FFDG PETCT adrenal imaging that determined the maximum standardized uptake value and the ratio of the maximum standardized uptake value in the adrenal tumor as compared with the spleen or liver effectively distinguished benign from malignant tumors (pooled sensitivities, 85 to 91%, and pooled specificities, 89 to 91%).",
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-    "text": "39 Adrenal Biopsy Biopsy of an adrenal incidentaloma is rarely indicated, 33 since it has low accuracy for distinguishing benign from malignant adrenal tumors and may lead to tumor seeding if the mass is an adrenocortical carcinoma.",
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-    "text": "An exception is the rare case in which adrenal metastasis is strongly suspected and biopsy confirmation would change the treatment plan; in such cases, biochemical testing to exclude a pheochromocytoma should be performed first to avoid precipitation of a hyperadrenergic crisis by biopsy.",
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-    "text": "Assessment of Bilateral Adrenal Masses Approximately 15% of patients with adrenal incidentaloma have bilateral adrenal masses.",
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-    "text": "40 The differential diagnosis of bilateral adrenal masses includes primary bilateral macronodular adrenal hyperplasia and adenomas, bilateral pheochromocytomas, congenital adrenal hyperplasia, bilateral adrenal hyperplasia due to Cushings disease or ectopic corticotropin secretion, metastases or primary cancers, myelolipomas, infections, hemorrhage, and partial glucocorticoid resistance.",
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-    "text": "In addition to the hormonal assessments described for a solitary adrenal incidentaloma, measurement of the serum 17-hydroxyprogesterone level is indicated to rule out congenital adrenal hyperplasia.",
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-    "text": "41 In addition, if bilateral adrenal masses appear on imaging to be hemorrhagic or infiltrative, the patient should undergo testing for adrenal insufficiency.",
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-    "text": "In patients with bilateral adrenal masses, the imaging characteristics of each adrenal lesion should be evaluated independently in determining appropriate management.",
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-    "text": "Followup in Patients with Nonfunctioning Lesions Nonfunctioning adrenal incidentalomas with features that are consistent with an adenoma on imaging (10 Hounsfield units) and that are smaller than 4 cm in greatest diameter usually have a benign course and do not warrant additional followup imaging.",
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-    "text": "In a metaanalysis involving 4121 patients with nonfunctioning adrenal lesions, the mean tumor growth was 2 mm over a median of 52.",
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-    "text": "5% of the patients had tumor enlargement of 1 cm or more, and adrenocortical carcinoma did not develop in any of the patients.",
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-    "text": "15 Followup with imaging and biochemical tests is recommended for patients with nonfunctioning tumors with indeterminate features on imaging.",
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-    "text": "Areas of Uncertainty The diagnostic criteria for and management of mild autonomous cortisol excess are uncertain.",
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-    "text": "Sherlock M, Scarsbrook A, Abbas A, et al.",
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-    "text": "Endocr Rev 2020; 41: 775-820.",
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-    "text": "Papanicolas I, Woskie LR, Jha AK.",
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-  },
-  {
-    "text": "Barzon L, Sonino N, Fallo F, Palu G, Boscaro M.",
-    "tokenCount": 21,
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-    "hash": "e5b1c7f2463e595552561ae27cf2e2151053a2e1635ac81da9f8ba079cdbb037"
-  },
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-    "text": "Prevalence and natural history of adrenal incidentalomas.",
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-    "text": "Eur J Endocrinol 2003; 149: 273-85.",
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-  },
-  {
-    "text": "Mantero F, Terzolo M, Arnaldi G, et al.",
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-    "hash": "38515ca4f3cec015690dce8ebd98c7d9f9ab311f01923dd837bc5028ce81e72f"
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-    "text": "A survey on adrenal incidentaloma in Italy.",
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-  },
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-    "text": "J Clin Endocrinol Metab 2000; 85: 637-44.",
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-  },
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-    "text": "Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital.",
-    "tokenCount": 21,
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-  {
-    "text": "Clin Endocrinol (Oxf ) 2002; 56: 95-101.",
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-  },
-  {
-    "text": "Fassnacht M, Arlt W, Bancos I, et al.",
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-    "text": "Eur J Endocrinol 2016; 175: G1-G34.",
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-  },
-  {
-    "text": "Sbardella E, Minnetti M, DAluisio D, et al.",
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-    "text": "Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas.",
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-    "text": "Ferreira L, Oliveira JC, Palma I.",
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-    "hash": "e432d500ca060de66323eaf194d1348e883945ad1b731c7e07c5b3d8663631d9"
-  },
-  {
-    "text": "J Endocrinol Metab 2018; 8: 62-8.",
-    "tokenCount": 14,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "908d00b96083920f02046fca3592060d415c6d74c1cd56a8123883ab334daf27"
-  },
-  {
-    "text": "Chiodini I, Torlontano M, Carnevale V, et al.",
-    "tokenCount": 19,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "78d5e9b1fd355ec865c9f1800331f791a513588bb4e73d82a0424a036a5da0e2"
-  },
-  {
-    "text": "Bone loss rate in adrenal incidentalomas: a longitudinal study.",
-    "tokenCount": 13,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "273f0d56729d7fdb2e8dd8f995bd1077431ee99f22c4e27b5250e60d9383db1a"
-  },
-  {
-    "text": "J Clin Endocrinol Metab 2001; 86: 5337-41.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "852fbb53fe7a3d043c5db50ad700ef1d70ce2b766741f6254c355f78d697f85e"
-  },
-  {
-    "text": "Valli N, Catargi B, Ronci N, et al.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "f7894d3fac3f25365a6532670c2d54560ad126f728d84937f1546116cd525f20"
-  },
-  {
-    "text": "Biochemical screening for subclinical cortisolsecreting adenomas amongst adrenal incidentalomas.",
-    "tokenCount": 19,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "dca90a2d82704a2e925690c05be8a46e13c33776cbd931b185e975ca9b6a89d6"
-  },
-  {
-    "text": "Eur J Endocrinol 2001; 144: 401-8.",
-    "tokenCount": 14,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "a69dcd706ed45a5cbb6bbccff8aa098528b10599c158f2ae52f9c1955d00f0c8"
-  },
-  {
-    "text": "Dennedy MC, Annamalai AK, PrankerdSmith O, et al.",
-    "tokenCount": 20,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "be7da658ed7a5d486a62825ef3aee0c70e9a63198081f2cbb6504bc71416bfcb"
-  },
-  {
-    "text": "Low DHEAS: a sensitive and specific test for the detection of subclinical hypercortisolism in adrenal incidentalomas.",
-    "tokenCount": 27,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "32cc7df016aab461a5c8a211c695e4d4948f200655fa2e9416831f841265b579"
-  },
-  {
-    "text": "J Clin Endocrinol Metab 2017; 102: 786-92.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "6000d4994f532328627ec994d37b4726d14df363ccb289149549952090926e5f"
-  },
-  {
-    "text": "Elhassan YS, Alahdab F, Prete A, et al.",
-    "tokenCount": 20,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "be3451da1bda61118165cb2cbc3f284db2666b8b05abb90f17248553dc515d28"
-  },
-  {
-    "text": "Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess: a systematic review and metaanalysis.",
-    "tokenCount": 22,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "e3dfe7b39427e10b012bd0b469494ca8d2f0cacaa8a496ded1121c4bc7ef20f2"
-  },
-  {
-    "text": "Ann Intern Med 2019; 171: 107-16.",
-    "tokenCount": 11,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "4ab3ce1e8d75eaa38110e51083e3118e927524ad6f766bfa3a71d3b69b97971f"
-  },
-  {
-    "text": "Morelli V, Palmieri S, Lania A, et al.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "e36d14266a4984e879c94cb07bcd57ff9a48d52ea8030323fe648ac9360bdf53"
-  },
-  {
-    "text": "Cardiovascular events in patients with mild autonomous cortisol secretion: analysis with artificial neural networks.",
-    "tokenCount": 17,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "084535d8a18b54d5c1e881db5aa3623b4a4ac4ae573e02e7c07e97005d50a261"
-  },
-  {
-    "text": "Eur J Endocrinol 2017; 177: 73-83.",
-    "tokenCount": 14,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "ee00b1228fec49acab50fcf0624348064d811f26bc17cc4b81dbbc444eba04db"
-  },
-  {
-    "text": "Patrova J, Kjellman M, Wahrenberg H, Falhammar H.",
-    "tokenCount": 21,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "af47917d9878f62833606b0d686a8318569e98c39c21b8be0a373d2cd60445e9"
-  },
-  {
-    "text": "Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center.",
-    "tokenCount": 24,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "d0b6a7195cfbc293f3bff36ce4b644c43544b34ca4809cd3bf10265ed8db4d26"
-  },
-  {
-    "text": "Endocrine 2017; 58: 267-75.",
-    "tokenCount": 10,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "4211215f80c71823e4bc196e2c71313c75f7fb285e947ea767832186b5490805"
-  },
-  {
-    "text": "Di Dalmazi G, Vicennati V, Garelli S, et al.",
-    "tokenCount": 19,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "8af8ccde1afd5a1fdf5ef416fba975684b88c7833621fd4040e7cbeb1e5b4b45"
-  },
-  {
-    "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": 10,
-    "pageEnd": 10,
-    "hash": "3571ed39d1efbaea4a855d700c3f333abae1f5e87a90c18ef36294673e51d3b1"
-  },
-  {
-    "text": "Lancet Diabetes Endocrinol 2014; 2: 396-405.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "27781eeec7d5f154ef8279c77dd6e429623d6103035f83ec607bdef252cb845c"
-  },
-  {
-    "text": "Park J, De Luca A, Dutton H, Malcolm JC, Doyle MA.",
-    "tokenCount": 18,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "63f218f0d1d1409d8c836a8e3bc988c48d2eb2dcf956a9b3fc825c9a1b69b96f"
-  },
-  {
-    "text": "Cardiovascular outcomes in autonomous cortisol secretion and nonfunctioning adrenal adenoma: a systematic review.",
-    "tokenCount": 21,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7d2d9c15133dacddf62b0d226d4d3a82c8c76c5790f958409c49a46299088291"
-  },
-  {
-    "text": "J Endocr Soc 2019; 3: 996-1008.",
-    "tokenCount": 14,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "884e389cb9d866acc25516e8ba2ece24c9ff58344bbd8288338c6d7fa5a3d088"
-  },
-  {
-    "text": "Debono M, Bradburn M, Bull M, Harrison B, Ross RJ, NewellPrice J.",
-    "tokenCount": 22,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "35d56975d3d793245a5301913bee3f2bc8b284f137bdc0851437a91bd31c8369"
-  },
-  {
-    "text": "Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas.",
-    "tokenCount": 21,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "b3f55a97b987caf1954271a35de06a9e098522c44457c712df51d22346eb1626"
-  },
-  {
-    "text": "J Clin Endocrinol Metab 2014; 99: 4462-70.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "6142a3e976a9ed8134968f440e0b097d7c764c7e05027d82c12eea0a8ec3491c"
-  },
-  {
-    "text": "Toniato A, MeranteBoschin I, Opocher G, Pelizzo MR, Schiavi F, Ballotta E.",
-    "tokenCount": 31,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "2f6526b11bfedf082e602cfe4b5010a09a6382112562602a24295b9dd71f3ddf"
-  },
-  {
-    "text": "Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study.",
-    "tokenCount": 22,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "aed0ae18016c1d29877c53870a53ad227a1a7d95ea645ce62c34924412feea68"
-  },
-  {
-    "text": "Ann Surg 2009; 249: 388- 91.",
-    "tokenCount": 11,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "dcc71fa79fdc46112a9cd18f7ef835ad625f0125dac0f4c29831f8aa5ed91e55"
-  },
-  {
-    "text": "Perysinakis I, Marakaki C, Avlonitis S, et al.",
-    "tokenCount": 19,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "ce3c037d39f204f755d034b7802aa700caf6d59d9c0193e6520cf8f1c0604ee4"
-  },
-  {
-    "text": "Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "1a420e89baa18c05dfd4a20b0ef848027bed313906ae98e90df5a31ef0c486bd"
-  },
-  {
-    "text": "Surg Endosc 2013; 27: 2145-8.",
-    "tokenCount": 13,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "febe7e8314ffdc49fe38604b77495f0e04c14c149862a6b07d2d68bf43bfbf33"
-  },
-  {
-    "text": "Iacobone M, Citton M, Viel G, et al.",
-    "tokenCount": 17,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "fb384dff60db8bc178bfd83a2b215aa8954219d3179ed55ad8fffa965951f27f"
-  },
-  {
-    "text": "Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushings syndrome.",
-    "tokenCount": 33,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7ef5656d9d2eadc5dabe02f7959adb413825b613ac0f9b93b0f3d333ad2c0b2e"
-  },
-  {
-    "text": "Surgery 2012; 152: 991-7.",
-    "tokenCount": 11,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "fc0c7f84b8343532e468ca5ea728775d218110a56bdf7587a3b2a48ca8f610fc"
-  },
-  {
-    "text": "Zeiger MA, Thompson GB, Duh QY, et al.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "8338205c67d92ed7c06313449c10edebf3bfb86dc62078c0586fe006f03be49d"
-  },
-  {
-    "text": "American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas: executive summary of recommendations.",
-    "tokenCount": 31,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "cbb19e1f22245b66ca214150c52cf7205dc490161d3913f900439b35884d09ef"
-  },
-  {
-    "text": "Endocr Pract 2009; 15: 450-3.",
-    "tokenCount": 11,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "51a60c1d7f5c7155c141a402b458f8b76e969500be963247d6584d8d2b1da217"
-  },
-  {
-    "text": "Tabarin A, Bardet S, Bertherat J, et al.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "44c7d3104b1a13011a6a1fe972a38eb1bfb273b0af477426a8486eec1d0144ad"
-  },
-  {
-    "text": "Exploration and management of adrenal incidentalomas.",
-    "tokenCount": 10,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "d2ed9c9dbc3459745e5517c480c5c04cba0eb05b6c92a4f46415c1a769b80486"
-  },
-  {
-    "text": "Ann Endocrinol (Paris) 2008; 69: 487-500.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "bdc90978a5bf120330eed485b267e9e88f4f6f0a590f95ff0397b303d1c11b6c"
-  },
-  {
-    "text": "Terzolo M, Stigliano A, Chiodini I, et al.",
-    "tokenCount": 18,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "d1a42f2c1567f845db7ad33bb2f89fa46dec5500f4aee0cfc4f4688634e8036a"
-  },
-  {
-    "text": "Eur J Endocrinol 2011; 164: 851-70.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "5650a4db7831a70e0b773269a0ba2b759acc5dbaff1bac39dec8ff74afd40cc2"
-  },
-  {
-    "text": "Lee JM, Kim MK, Ko SH, et al.",
-    "tokenCount": 12,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "e0a98ce1fdd21e01dd787fbf0fc81aa5c80e0376e27fe5bbd2ef5e47a9afd2c3"
-  },
-  {
-    "text": "Clinical guidelines for the management of adrenal incidentaloma.",
-    "tokenCount": 12,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "ffc9279ae71b148952f26a0039cf86247cd077e0a07fdebc4491374d00ee2df1"
-  },
-  {
-    "text": "Endocrinol Metab (Seoul) 2017; 32: 200-18.",
-    "tokenCount": 17,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "379d6ed7ddd26f8b453f6816fd59557a7b8b0f6119429ad740e0bd7b9cf403c4"
-  },
-  {
-    "text": "Canu L, Van Hemert JAW, Kerstens MN, et al.",
-    "tokenCount": 18,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7fd7fca66fb96397d6117b9bba96f295f25c4717994cd9600bb43df7e5fc918d"
-  },
-  {
-    "text": "CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma.",
-    "tokenCount": 21,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7169d7555ba3ff4c7cb1d3a9266c89f2ec664e686e78f871a155a8cafab086f1"
-  },
-  {
-    "text": "J Clin Endocrinol Metab 2019; 104: 312-8.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "73881f9e47bf45beca7b6d5b3a241e241fb51ad211455cfb15b6898fb597c582"
-  },
-  {
-    "text": "Buitenwerf E, Korteweg T, Visser A, et al.",
-    "tokenCount": 21,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "bb0ad863bf28925836b93d5b6d5be9c13d0b0c4c31ffc55a2d5835a8f68722e5"
-  },
-  {
-    "text": "Unenhanced CT imaging is highly sensitive to exclude pheochromocytoma: a multicenter study.",
-    "tokenCount": 23,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "e02f92bc47f14058bc68a76856bf4a0105586a16abf2b90f7569a029e355e90d"
-  },
-  {
-    "text": "Eur J Endocrinol 2018; 178: 431-7.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "ebddf87ce1f64fab663c1698cc8a1e5a94c40825c4e26e2e48657e7a81303c63"
-  },
-  {
-    "text": "Lenders JWM, Duh QY, Eisenhofer G, et al.",
-    "tokenCount": 18,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "57ef4a6b0c8e500d8eadc9a3b8d90a106e84ee2b79437eb5fee00ce6c7eb82ee"
-  },
-  {
-    "text": "Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline.",
-    "tokenCount": 22,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7b2fcac91005c3a422efc10e2c3c477f55efa700e5d1cc7ecdc4245866e4b35b"
-  },
-  {
-    "text": "J Clin Endocrinol Metab 2014; 99: 1915-42.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "0a093d82bdc3edd15c439c3e1d55a2234d42e507d7f1a21a03023b4a39b2d966"
-  },
-  {
-    "text": "Funder JW, Carey RM, Mantero F, et al.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "3bd9fd907b5381c0ad13255b58af75531ad4cbe07cb2e4aa725701608b4f1ac4"
-  },
-  {
-    "text": "The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline.",
-    "tokenCount": 26,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "11de25db79548c7dc3db2119eb70b04209814f8dea46b0f152bcf008e12f7466"
-  },
-  {
-    "text": "J Clin Endocrinol Metab 2016; 101: 1889-916.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "16e6ff01469d29521ad977972482e8b53cb09ca833cfeb8aba12bb82d78f873f"
-  },
-  {
-    "text": "Reznik Y, Amar L, Tabarin A.",
-    "tokenCount": 12,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "63725793e1a670ad2b3364591b932cbceb4df00d928e6927454508a4940c1ef9"
-  },
-  {
-    "text": "SFE/ SFHTA/AFCE consensus on primary aldosteronism.",
-    "tokenCount": 19,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "2d84930b92f0f0c2fd61916fa6f4384a3a6d944753904391d0eb68591c1f388f"
-  },
-  {
-    "text": "Ann Endocrinol (Paris) 2016; 77: 202-7.",
-    "tokenCount": 15,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "6d2784be4fc4bf0d2b5bac91f4559fde0d4a4443ba1f2c53c728cd8aad1f26bd"
-  },
-  {
-    "text": "Bancos I, Tamhane S, Shah M, et al.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "286f23083f73e8542ba5a2d48574bc75cfab49c5bec0ce4fc56321e5c7ea75a8"
-  },
-  {
-    "text": "Diagnosis of endocrine disease: the diagnostic performance of adrenal biopsy: a systematic review and metaanalysis.",
-    "tokenCount": 24,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7f6151a0bf46f609ae281736c667286dc9e2fa247535c49706b41a6be4fde81c"
-  },
-  {
-    "text": "Eur J Endocrinol 2016; 175: R65-R80.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "f9247d2aff72e25739e889f92d54991cc898795de212a6540860f8adc09a2de2"
-  },
-  {
-    "text": "Dinnes J, Bancos I, Ferrante di Ruffano L, et al.",
-    "tokenCount": 21,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "b925770393c4a3e849b472af35d58a4e0bb489ff2aef366bd48a7431fbea297e"
-  },
-  {
-    "text": "Management of endocrine disease: imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and metaanalysis.",
-    "tokenCount": 28,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "7d1643b28bc9da7844b0b223ea50986f20231eabbe319f8359f85d2f56415938"
-  },
-  {
-    "text": "Eur J Endocrinol 2016; 175: R51-R64.",
-    "tokenCount": 16,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "c27d1ba2140d120a59c6883e0fdbd34e28118468a209c542baecd36feb56cd61"
-  },
-  {
-    "text": "NIH stateofthescience statement on management of the clinically inapparent adrenal mass (incidentaloma).",
-    "tokenCount": 23,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "62c53c848538a9877c4c6577fc53a8dc988c16440c7e2b14970dfb909a493adc"
-  },
-  {
-    "text": "NIH Consens State Sci Statements 2002; 19(2): 1-25.",
-    "tokenCount": 17,
-    "pageStart": 10,
-    "pageEnd": 10,
-    "hash": "ea9c056cfc53932a57f1a759d77172bafb198ca5df6da62c482827b61b3cbcbc"
-  },
-  {
-    "text": "Sturgeon C, Shen WT, Clark OH, Duh QY, Kebebew E.",
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-    "pageStart": 10,
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-    "text": "Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy?",
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-    "text": "J Am Coll Surg 2006; 202: 423-30.",
-    "tokenCount": 13,
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-    "text": "Platzek I, Sieron D, Plodeck V, Borkowetz A, Laniado M, Hoffmann RT.",
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-    "text": "Eur Radiol 2019; 29: 806-17.",
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-    "text": "Buitenwerf E, Berends AMA, van Asselt ADI, et al.",
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-    "text": "Diagnostic accuracy of computed tomography to exclude pheochromocytoma: a systematic review, metaanalysis, and cost analysis.",
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-    "text": "Mayo Clin Proc 2019; 94: 2040-52.",
-    "tokenCount": 13,
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-    "text": "Kim SJ, Lee SW, Pak K, Kim IJ, Kim K.",
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-    "text": "Diagnostic accuracy of 18 FFDG PET or PET/CT for the characterization of adrenal masses: a systematic review and metaanalysis.",
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-    "text": "Br J Radiol 2018; 91(1086): 20170520.",
-    "tokenCount": 15,
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-    "text": "Bourdeau I, El Ghorayeb N, Gagnon N, Lacroix A.",
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-    "hash": "eeb8b22cbff412a76bf7415123a1c2d49b05bd23f15f7e98f794da3aad07e855"
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-    "text": "Management of endocrine disease: differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas.",
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-    "text": "Eur J Endocrinol 2018; 179: R57-R67.",
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-    "text": "Congenital adrenal hyperplasia due to 21-hydroxylase deficiency presenting as adrenal incidentaloma: a systematic review and metaanalysis.",
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-    "text": "Endocr Pract 2016; 22: 736-52.",
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Capstone Course Adrenal Nodule information/FINAL Adrenal Nodual Workflow Flyer copy.pdf_semantic.json

@@ -1,79 +0,0 @@
-[
-  {
-    "text": "Evaluating adrenal nodules *See next page for hormonal workup reference Incidental adrenal nodule > 1 cm Found on noncontrast (noncon) CT? DO NOT BIOPSY adrenal mass without hormone workup and consulation Assess imaging characteristics Obtain adrenal protocol CT Suspicious appearance Hormonal workup* Abnormal DST or metanephrines or aldosterone : renin Normal hormonal workup Refer to Endocrine Surgery Adrenal Nodules Clinic Benign appearance Hormonal workup*  Size 4 cm in diameter  >10 Hounsfield units (HU) on noncon CT  CT contrast washout <4060%  On MRI, hyperintense on T2 imaging or no signal loss on chemicalshift analysis  On 18FFDG PETCT, SUVmax 5 or adrenaltospleen or adrenalto liver signalintensity ratio 1  Catecholamine Excess  Plasma fractionated metanephrines  Abnormal: >2x Upper Limit of Normal (ULN)  Adrenal hypercortisolism  1mg Dexamethasone suppression test (DST)  Abnormal: >1.",
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-  },
-  {
-    "text": "8 mcg/dl  Adrenal hyperaldosteronism  If patient has a history of HTN  Plasma aldosterone and renin  Abnormal: aldosterone >10 and renin <1.",
-    "tokenCount": 45,
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-  {
-    "text": "0  Size 1-4 cm in diameter  10 Hounsfield units (HU) on noncon CT  CT contrast washout 4060%  Signal loss on MRI chemicalshift analysis  On 18FFDG PETCT, SUVmax <5 or adrenaltospleen or adrenalto liver signalintensity ratio <1  Adrenal hypercortisolism  1mg Dexamethasone suppression test (DST)  Abnormal: >1.",
-    "tokenCount": 98,
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-    "hash": "c0856ceebb215d78fdb6cc48aa989c431b41e64d7b7bedef70a9c1c66705bfbd"
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-  {
-    "text": "GS-2727550-26 Hormonal workup reference 1.",
-    "tokenCount": 14,
-    "pageStart": 2,
-    "pageEnd": 2,
-    "hash": "49eb5fab9f931acf8fe0a5d0cb34dde8bf014609308ea0b2ff8b4c7d075b5ab1"
-  },
-  {
-    "text": "Cortisol evaluation Dexamethasone Suppression Test (DST)  Prescribe 1 mg of oral dexamethasone to be taken at 11 pm  The next morning at 8 am, a cortisol and dexamethasone level are drawn  If the 8 am cortisol is < 1.",
-    "tokenCount": 64,
-    "pageStart": 2,
-    "pageEnd": 2,
-    "hash": "530bedc3c137603793ac35fc6ae82c23cce814d4f7b2219e6654a434a6d62d86"
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-  {
-    "text": "8 mcg/dL, cortisol excess is ruled out  If the am cortisol after dexamethasone is >1.",
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-  {
-    "text": "8mcg/dL, then screening is POSITIVE or ABNORMAL  Cortisol between 1.",
-    "tokenCount": 22,
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-    "hash": "0c9b32ff332487d924156603b138547204174acf5a019d8a9f6166e155e91020"
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-  {
-    "text": "0 mcg/dL may represent mild cortisol excess, therefore you need to proceed with confirmatory testing:  Morning serum corticotropin and cortisol levels  24-hr urinary cortisol  3 midnight/latenight salivary cortisol  Midnight serum cortisol  DHEAS (<40 mcg/dL)  Failure to suppress below 5. 0 mcg/dL raises concern for cortisol excess 2.",
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-  {
-    "text": "Screen for aldosteronoma Aldosterone level : Plasma Renin Activity (PRA)  Perform if patient has a history of hypertension or hypokalemia  Obtain midmorning plasma aldosterone concentration and plasma renin activity  These must be drawn at the same time and should not be done with the DST  Divide the aldosterone level by the PRA to calculate the aldosterone : renin (ARR)  If the ARR is > 20, screen is POSITIVE or ABNORMAL for hyperaldosteronism  If aldosterone > 10 ng/dL AND renin < 1.",
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-  {
-    "text": "0 ng/dL then screen is POSITIVE or ABNORMAL for hyperaldosteronism  Proceed to confirmatory testing with oral sodium load test, aldosterone suppression test or seated saline infusion test  If aldosterone < 10 ng/dL OR renin > 1. 0 ng/dL, then screen is NEGATIVE or NORMAL for hyperaldosteronism  If aldosterone > 10 ng/dL AND renin > 1.",
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-  {
-    "text": "0 ng/dL and is on a potentially interfering medication, then hold/replace medications for 4 weeks and repeat 3.",
-    "tokenCount": 24,
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Capstone Course Adrenal Nodule information/Unveiling the Silent Threat_ Disparities in Adrenal Incidentaloma Management.pdf_semantic.json

@@ -1,1822 +0,0 @@
-[
-  {
-    "text": "Unveiling the Silent Threat: Disparities in Adrenal Incidentaloma Management John P.",
-    "tokenCount": 20,
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-  },
-  {
-    "text": "OConnor, BS, a , * Alekya Poloju, MD, b Samantha K.",
-    "tokenCount": 21,
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-    "hash": "a9591869e5873355c693c6b6210c2d3256635004878fa2b8df35de555c118c63"
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-  {
-    "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,
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-    "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,
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-    "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,
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-  },
-  {
-    "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,
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-    "hash": "6020a62cd0a46c653e16243fc07a17494e4ddbb0cb625c23c0a94b03979b3231"
-  },
-  {
-    "text": "Patients from disadvantaged neighborhoods were significantly less likely to receive workup, as were patients seen through the emergency department.",
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-    "text": "All rights are reserved, including those for text and data mining, AI training, and similar technologies.",
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-    "text": "University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue H4/724, Madison, WI 53792.",
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-    "text": "Email address: jpoconnor4@wisc.",
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-    "text": "com journalofsurgicalresearch  july 2025 (311) 143 e 150 0022-4804/$ e see front matter  2025 Elsevier Inc.",
-    "tokenCount": 32,
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-  {
-    "text": "Introduction The prevalence of adrenal tumors has increased over the last several decades, largely due to advancements in imaging techniques.",
-    "tokenCount": 23,
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-    "hash": "9cb641042a19a42f719cd92b99622f04011f800fc065f8b99f6272974a4f99fc"
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-  {
-    "text": "1,2 As a result, the term adrenal incidentaloma was created to describe the abnormal unexpected finding.",
-    "tokenCount": 22,
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-    "hash": "ab23428ba0cbe510536177f44200f50bb5506f46c8049a029938e127f9c228e7"
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-    "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,
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-    "hash": "789fec963fa73bca012accc7e7c7855326d638902b4e24fb2b92109daaa5fcc0"
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-    "text": "4 Approximately 2%-8% of relevant imaging scans identify an IAM.",
-    "tokenCount": 15,
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-    "hash": "64840d364426e0a58e6c00939967ae8b21589f59a8bd7e4e3cb8ed15e3e68041"
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-    "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,
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-  },
-  {
-    "text": "6-8 All major endocrine, urologic, and radiologic societies recommend additional studies to determine neoplastic potential of IAMs.",
-    "tokenCount": 30,
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-    "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,
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-    "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,
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-    "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,
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-    "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,
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-  {
-    "text": "Radiology reports were screened for the key phrases Adrenal Nodule, Adrenal Mass, or Adrenal Incidentaloma to obtain scans with IAMs.",
-    "tokenCount": 34,
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-  {
-    "text": "Chart reviews were conducted to confirm the reported nodule and evaluate for followup imaging and biochemical evaluation.",
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-  {
-    "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.",
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-  {
-    "text": ", medical subspecialist, general surgery, and surgical subspecialty).",
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-  {
-    "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.",
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-  {
-    "text": "15 Charts abstractions were performed by two investigators (A.",
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-  },
-  {
-    "text": "), with validity and reliability confirmed after 20 doubly abstracted charts.",
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-  {
-    "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,
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-  {
-    "text": "The Internal Review Board of the University of Wisconsin e Madison reviewed this study and deemed it exempt from full review.",
-    "tokenCount": 22,
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-    "hash": "1a68ec5ac976998de39d6228ab6fe0ac3e9cd8d8d8fab294fb8fb59b111dd00b"
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-  {
-    "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,
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-  {
-    "text": "ADI is calculated using a methodology including 17 factors such as income, education, employment, and housing quality.",
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-  {
-    "text": "16,17 ADI creates a composite index to measure socioeconomic disadvantage within geographic areas, highlighting how communitylevel variables influence health outcomes.",
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-    "hash": "ffa8c649a544866a6749bf5eec1ecf213ab7e14613789fe6cf2f209845b797e8"
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-  {
-    "text": "The tool was validated using US census block data to rank neighborhood socioeconomic disadvantage.",
-    "tokenCount": 15,
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-  {
-    "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,
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-  {
-    "text": "18,19 Primary analysis examined rates at which patients received subsequent biochemical and radiologic evaluations within 2 y of their index scan.",
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-  {
-    "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.",
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-  {
-    "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.",
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-  {
-    "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,
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-  {
-    "text": "We considered partial workup as the completion of any, but not all, of these recommended tests.",
-    "tokenCount": 20,
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-    "hash": "21ab730831b165e455482edefb74f394626a904e37a54ef9dfcd37d6d850ec19"
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-  {
-    "text": "For certain analyses, partial and full workup were combined as any workup due to low numbers of partial and full workups.",
-    "tokenCount": 26,
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-  {
-    "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,
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-  {
-    "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.",
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-  },
-  {
-    "text": "To analyze clinical notes, two authors (J.",
-    "tokenCount": 10,
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-    "hash": "8a6d154ff4db0e663da8633a34f92c9fa841c193b931103edc0e0629c4d419ca"
-  },
-  {
-    "text": "Using a deductive thematic approach, noncompliance themes were identified and categorized.",
-    "tokenCount": 16,
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-    "hash": "8d6e6d5f33b5c532a72d184f821b3ad1ca8d8eedb84ebffa186f1a3451adab17"
-  },
-  {
-    "text": "Upon completion, themes were compared and differences were resolved by A.",
-    "tokenCount": 13,
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-    "hash": "2b390973b043c94ccaef1dd5953d10cadaf3b7acebcdfe32a296e945e5e03cf9"
-  },
-  {
-    "text": "categorizing clinical notes using our established themes with the ability to create new classifications if necessary.",
-    "tokenCount": 20,
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-    "hash": "ab9dcd524e98295168b85bbfe34c99963ae949aead4a4bc52af3541b1ea7b4e1"
-  },
-  {
-    "text": "Following completion, we again reviewed our results as a team to finalize our results.",
-    "tokenCount": 17,
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-    "hash": "432adbb1d25d847982fbd777197c2275f246b84c012ed26a231582c479a2d69e"
-  },
-  {
-    "text": "A bivariate analysis was performed using chisquared and Students ttest analysis.",
-    "tokenCount": 17,
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-  },
-  {
-    "text": "Multivariate logistic regression was performed to evaluate factors associated with biochemical workup.",
-    "tokenCount": 16,
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-  {
-    "text": "Results Study cohort During the study period, 9022 patients had a qualifying CT scan performed and 533 (5.",
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-  {
-    "text": "9%) individuals with IAMs were identified.",
-    "tokenCount": 10,
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-  },
-  {
-    "text": "0%) of 533 patients were included in our final analysis ( Fig.",
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-  {
-    "text": "Demographics Overall, the final patient cohort was 58.",
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-  {
-    "text": "0% over 65 y of age, and 86.",
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-  },
-  {
-    "text": "6% reporting a CCI of 0 or 1.",
-    "tokenCount": 11,
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-    "hash": "43814a9ca3f37bba5160750af84d0576ef8977fe2ed42bd2a962593edb3bd265"
-  },
-  {
-    "text": "The most common ADI deciles were 4 or 5, making up 17.",
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-    "text": "0%) were from advantaged neighborhoods (lower 50th percentile ADI).",
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-  {
-    "text": "Imaging and ordering provider characteristics The majority of the imaging which discovered the IAM was ordered by EM providers (50.",
-    "tokenCount": 24,
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-  {
-    "text": "6%), followed by subspecialists (36.",
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-    "text": "1% of ordering providers were physicians, while the remainder were physician assistants or nurse practitioners.",
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-  {
-    "text": "The vast majority of the CTs ordered were with contrast (93.",
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-  {
-    "text": "Rate of IAM workup Most (71%) IAM patients received no further workup, 18% had partialevaluation,and11%hadfullassessment( Fig.",
-    "tokenCount": 36,
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-  {
-    "text": "A chisquare test revealed statistically significant associations between sex, neighborhood disadvantage, and ordering provider with IAM workup.",
-    "tokenCount": 25,
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-  {
-    "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.",
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-  {
-    "text": "5% from PCPs, P < 0.",
-    "tokenCount": 10,
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-    "hash": "5259926197b18652554f0836f01f0553c138920e2b6cd4ed65eff90afc019f0f"
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-  {
-    "text": "8% had scans ordered by EM providers and 17. 8% had scans ordered by PCPs ( Table 2 ).",
-    "tokenCount": 23,
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-    "hash": "b446adad7c41046e905ec792aa48fd218c569dfcec3adcbcf532e650666b3da2"
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-  {
-    "text": "Of the disadvantaged patients, scans ordered by EM providers and PCPs were 45.",
-    "tokenCount": 16,
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-    "hash": "bc9a038a3fe92b5002cf78de3376bbd34fc790d989849344c69c56e0524ea12d"
-  },
-  {
-    "text": "Comparison of patients who hadapartialorfullworkupispresentedin Supplementary Table 1 .",
-    "tokenCount": 20,
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-  {
-    "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,
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-  {
-    "text": "Other factors significantly associated with receiving any workup included female sex (OR 2.",
-    "tokenCount": 16,
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-  {
-    "text": "31) and scans ordered by PCPs (OR 4.",
-    "tokenCount": 12,
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-  {
-    "text": "There was no statistically significant difference in workup based on age, race, ethnicity, insurance status, or CCI.",
-    "tokenCount": 24,
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-  },
-  {
-    "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,
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-  {
-    "text": "The most common theme of missed evaluation related to radiology reports recommending no further workup.",
-    "tokenCount": 18,
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-  },
-  {
-    "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,
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-    "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,
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-    "hash": "2e6dff2a9f7ed88d2878e2091861cba2a99366234648324405f259cbea1973b0"
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-  {
-    "text": "Second most common was PCPs not acknowledging the nodule nor ordering additional tests, suggesting these incidental findings were missed.",
-    "tokenCount": 23,
-    "pageStart": 3,
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-    "hash": "1c739631aa23da965b19735fdd23bfe172ad1a32f9c53010b4dbf023aa355df9"
-  },
-  {
-    "text": "patients were frequently lost to followup after imaging and never completed biochemical testing when recommended.",
-    "tokenCount": 18,
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-  {
-    "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,
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-    "hash": "2a65e42beaf429fd51c68699c024442d3d31eaa613ff343be5572ce381206050"
-  },
-  {
-    "text": "These alarmingly low rates align with other publications, confirming absent or incomplete IAM evaluations are commonplace.",
-    "tokenCount": 20,
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-    "hash": "f9e75031b7a6989bf8ae30e841a4858ede6f0a92df21685a88ef8351cf2f4cb7"
-  },
-  {
-    "text": "2,12 , 20 For instance, Ebbehoj et al .",
-    "tokenCount": 15,
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-    "hash": "b969f17959cafbc08cf63b0a58617d2c85a33cd247b560a4e29f8c14a4424282"
-  },
-  {
-    "text": "(2020) reported appropriate workup of IAMs was completed in only 15.",
-    "tokenCount": 17,
-    "pageStart": 4,
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-    "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,
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-    "hash": "c65d2d40db910bfb09b570ead5f37704a497841e815c6323f76fc3457fd507b3"
-  },
-  {
-    "text": "10,11 , 21 Workup rates were particularly low for patients living in disadvantaged neighborhoods.",
-    "tokenCount": 18,
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-    "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,
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-    "hash": "2b70c6b2ab41bc39264ac0d476465fd0338bddcbfd610454631d04c64ca949b1"
-  },
-  {
-    "text": "Our findings are consistent with literature linking neighborhoodlevel disadvantage with poorer health outcomes and disease management.",
-    "tokenCount": 18,
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-    "hash": "aea72adba63fa384c9ba769918ba9b4b48a1ec2d4bf8877bb9df1b926304f682"
-  },
-  {
-    "text": "22,23 Similarly, Schut and Mortani Barbosa (2020) reported racial/ethnic disparities in incidental pulmonary nodule management.",
-    "tokenCount": 27,
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-    "hash": "e74b5c023eef9fc85da4c4c4b49e0136de55fc6ac2f445a595f13a7c80fa33ce"
-  },
-  {
-    "text": "24 Differences in care of IAMs may have downstream effects, potentially exacerbating preexistent disparities in comorbidities such as diabetes and hypertension.",
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-  {
-    "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.",
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-  {
-    "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.",
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-    "text": "No workup (n  174) % Any workup (n  71) % Total cohort (n  245) % P value Sex < 0.",
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-  {
-    "text": "03 Advantaged ( < 50 percentile) 51.",
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-    "text": "0 Disadvantaged ( > 50 percentile) 48.",
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-  {
-    "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,
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-    "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,
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-    "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.",
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-    "text": "29 Interestingly, several previous publications focused on poor IAM workup compliance in primary care outpatient settings.",
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-    "text": "30,31 The authors suggested PCPs may lack time and/or knowledge of appropriate biochemical evaluations to adequately address IAMs.",
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-    "text": "However, our study suggests the emergency room as a potentially larger source of missed IAM management.",
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-    "text": "Although disadvantaged patients had higher rates of detection by EM providers, ordering provider remained a significant factor even when controlling for socioeconomic deprivation.",
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-    "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.",
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-    "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.",
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-    "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.",
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-    "text": "Another problem contributing to incomplete IAM evaluation is radiologists recommending no further workup.",
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-    "text": "Although radiologists rule out malignant potential and label the nodule as benign, biochemical workup is required to understand the functional potential.",
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-    "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.",
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-    "text": "33-35 While modifications to radiology reporting language (e.",
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-  {
-    "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.",
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-    "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.",
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-    "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,
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-    "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,
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-    "text": "DST [ dexamethasone suppression test; HTN [ hypertension.",
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-    "text": "Ordering provider ADI Advantaged ( < 50 percentile) Disadvantaged ( > 50 percentile) N% n % EM 74 54.",
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-  {
-    "text": "It is not hard to imagine positive resources directed to identify IAM patients may be unequally distributed and benefit wellresourced clinics.",
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-  {
-    "text": "Thus, to further improve health outcomes and equity, interventions must consider the patient population and setting.",
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-  {
-    "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.",
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-    "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.",
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-    "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.",
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-    "text": "We found a major obstacle for patients in disadvantaged communities is following up with PCPs after the identification of an IAM.",
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-    "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,
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-    "text": "This strategy has demonstrated success in improving cancer management and treatment.",
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-    "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.",
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-    "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.",
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-    "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.",
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-    "text": "For one, retrospective data and inherent inaccuracies in the electronic medical record may skew results.",
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-    "text": "The data were only from a single institution and the population skewed more toward White and insured, making the results less generalizable.",
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-    "text": "Including a greater percentage of nonWhite or Medicaid patients could allow for further elucidation of barriers to workup which specifically constrain these populations.",
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-    "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.",
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-    "text": "We are also unable to determine any verbal or other communication provided to the patient regarding their identified nodule.",
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-  {
-    "text": "Variable OR (95% CI) Sex Male ref Female 2.",
-    "tokenCount": 13,
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-    "text": "31) Age > 65 ref < 65 1.",
-    "tokenCount": 10,
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-  {
-    "text": "73) Race/Ethnicity White ref Black 1.",
-    "tokenCount": 12,
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-  {
-    "text": "88) Other * Ordering provider ED ref PCP 4.",
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-    "text": "01) ADI < 50 ref > 50 0.",
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-  {
-    "text": "48) Tricare * * Not enough patients for analysis.",
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-    "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,
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-    "hash": "c60bed8f5104a0f35e975c5c09988f9a194ba43bcbbfbfb243e2f68b7affeb9a"
-  },
-  {
-    "text": "No followup imaging is necessary Partially imaged, indeterminant 4.",
-    "tokenCount": 16,
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-    "hash": "c90cbdf023d4820faddbfa6a75b8dbf44bf5203e489372e0dc832473bd40bd54"
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-  {
-    "text": "6 cm right adrenal mass, likely adenoma or adrenal myelolipoma, both benign.",
-    "tokenCount": 23,
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-    "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,
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-    "hash": "2d631ae163737044fc47ac2130736998000d6b4ee026b032cfadc52b1f9d9dbf"
-  },
-  {
-    "text": "MR  magnetic resonance; MRI  magnetic resonance imaging.",
-    "tokenCount": 11,
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-    "hash": "7811b3d2bd18aca0fc3709090f32512c8c6ee4642c3343e8c4647e99cae9cc24"
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-  {
-    "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,
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-    "hash": "ab29dfc491d0f875957e405a4d868a4615d1423b8840fd27ae1158d8ce3c9755"
-  },
-  {
-    "text": "Patient neighborhood disadvantage and studies ordered by EM providers were associated with lower rates of biochemical workup.",
-    "tokenCount": 20,
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-    "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,
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-    "hash": "6f7f027357380f514a13f3469b3062a84395c2f77b32b7bf4888dc332b112775"
-  },
-  {
-    "text": "Supplementary Materials Supplementary data related to this article can be found at https://doi.",
-    "tokenCount": 17,
-    "pageStart": 7,
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-    "hash": "4162caf3be37d9c7e0740995ed2c0d87f86c09c17ec11a8bf79ae4e65ca27299"
-  },
-  {
-    "text": "OConnor reports that financial support was provided by Herman and Gwendolyn Shapiro Foundation.",
-    "tokenCount": 17,
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-    "pageEnd": 7,
-    "hash": "45d1652351fa4976f32e7075d70bd1f879daf13fc091f2a0fc9719a5d52e0fd8"
-  },
-  {
-    "text": "Amy Kind reports financial support was provided by National Institute on Aging.",
-    "tokenCount": 13,
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-    "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.",
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-    "hash": "1ae57b40fce5c4bd15f235a228c19c92023efe715ef24ab0dc73c734bef06647"
-  },
-  {
-    "text": "CRediT authorship contribution statement John P.",
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-  {
-    "text": "OConnor: Writing e review & editing, Writing e original draft, Investigation, Formal analysis, Data curation.",
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-  },
-  {
-    "text": "Alekya Poloju: Investigation, Formal analysis, Data curation.",
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-    "hash": "5085a4802c9b2f99f6efc4f5bc04c3b020e867e3483b924419a7778025990478"
-  },
-  {
-    "text": "Pabich: Project administration, Methodology, Data curation.",
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-  },
-  {
-    "text": "Betty Allen: Investigation, Data curation.",
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-    "hash": "c66634c5fc63376477c587b92dc2c1e8741ee19458852a34d641bd33921632d2"
-  },
-  {
-    "text": "Rebecca Sippel: Supervision, Project administration, Methodology. Amy Kind: Supervision, Methodology.",
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-  {
-    "text": "Alexander Chiu: Writing e review & editing, Validation, Supervision, Project administration, Methodology, Formal analysis, Data curation, Conceptualization.",
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-    "text": "Sherlock M, Scarsbrook A, Abbas A, et al.",
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-    "text": "Ebbehoj A, Li D, Kaur RJ, et al.",
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-    "text": "Fassnacht M, Arlt W, Bancos I, et al.",
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-    "text": "Sconfienza E, Tetti M, Forestiero V, Veglio F, Mulatero P, Monticone S.",
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-    "text": "Di DG, Vicennati V, Garelli S, et al.",
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-  {
-    "text": "Morelli V, Reimondo G, Giordano R, et al.",
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-    "text": "Abrahamowicz AA, Ebinger J, Whelton SP, CommodoreMensah Y, Yang E.",
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-    "text": "Hussein M, Diez Roux AV, Field RI.",
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-    "text": "Feeney T, Talutis S, Janeway M, et al.",
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-    "text": "Talutis SD, Childs E, Goldman AL, et al.",
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Capstone Course Adrenal Nodule information/primary-aldosteronism Family Medicine Clinical Guidelines.pdf_semantic.json

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-    "text": "September 2023  Volume 108, Number 3 www.",
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-    "text": "org/afp American Family Physician 273 Primary aldosteronism, first described by Dr.",
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-    "text": "Jerome Conn in 1955, has long been considered a rare secondary cause of hypertension.",
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-    "text": "1 Newer evidence, however, suggests that primary aldosteronism is common and largely underrecognized.",
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-    "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.",
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-    "text": "3 Even for patients with an indication for case detection, appropriate testing is performed in only 1.",
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-    "text": "4,5 This underrecognition of primary aldosteronism can lead to delayed diagnosis and treatment, which can cause irreversible endorgan damage.",
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-    "text": "6 Background Primary aldosteronism is the overproduction and oversecretion of aldosterone, occurring independently of the reninangiotensinaldosterone system (RAAS).",
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-    "text": "Aldosterone can cause sodium retention and potassium excretion in the renal tubules.",
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-    "text": "Aldosterone (mineralocorticoid) receptors are also present in vascular endothelial smooth muscle cells and the myocardium.",
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-    "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 ) .",
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-    "text": "(Bruin) Rugge, MD; and Olga Senashova, MD Oregon Health & Science University, Portland, Oregon CME This clinical content conforms to AAFP criteria for CME.",
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-    "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.",
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-    "text": "However, it is estimated that only about 2% of patients who have risk factors for primary aldosteronism have been formally tested or diagnosed.",
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-    "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.",
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-    "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.",
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-    "text": "After a positive case detection, confirmatory testing should be performed.",
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-    "text": "Confirmatory tests include the captopril challenge, oral or intravenous salt loading, or fludrocortisone suppression.",
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-    "text": "Results are positive if aldosterone levels remain high after interventions that suppress or interrupt physiologic production of aldosterone.",
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-    "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.",
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-    "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.",
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-    "text": ") TABLE 1 Adverse Effects of Primary Aldosteronism Compared With Essential Hypertension Risk Odds ratio (95% CI) Atrial fibrillation 3.",
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-    "text": "org/afp Volume 108, Number 3  September 2023 PRIMARY ALDOSTERONISM Case Detection The first step in diagnosing primary aldosteronism is case detection.",
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-    "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) .",
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-    "text": "13 Normokalemia should not dissuade clinicians from considering the diagnosis of primary aldosteronism.",
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-    "text": "Hypokalemia is the exception, not the rule, and is seen in only about 30% of patients with primary aldosteronism.",
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-    "text": "14 Initial case detection for primary aldosteronism is performed by simultaneously measuring plasma aldosterone concentration and plasma renin activity.",
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-    "text": "10 Aldosterone elevation with suppressed plasma renin activity identifies patients with potential primary aldosteronism 10,13 (Figure 1 10,13,15 ) .",
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-    "text": "An aldosteronerenin ratio of greater than 30 is considered positive.",
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-    "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) .",
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-    "text": "13 Confirmatory Testing Confirmatory testing is often needed to make a formal diagnosis of primary aldosteronism.",
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-    "text": "However, in some patients with a high probability of primary aldosteronism based on clinical presentation and initial biochemical screening (e.",
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-    "text": ", spontaneous hypokalemia [potassium level of less than 3.",
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-    "text": "5 mEq per L] with suppressed plasma renin activity and elevated plasma aldosterone concentration), confirmatory testing can be omitted.",
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-    "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.",
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-    "text": "15 For patients who require confirmatory testing, several tests are available, but there is no consensus on which one is preferred.",
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-    "text": "17 Test results are considered positive when aldosterone levels remain elevated despite an intervention that would suppress physiologic aldosterone production.",
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-    "text": "Salt loading and synthetic mineralocorticoid administration can worsen hypertension and hypokalemia; therefore, monitoring of blood pressure and serum potassium levels is recommended.",
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-    "text": "These tests are timeconsuming and require meticulous attention to detail; therefore, physicians may consider referral to an endocrinologist for confirmatory testing.",
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-    "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.",
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-    "text": "In patients without primary aldosteronism, interruption of the RAAS by an angiotensinconverting enzyme inhibitor will cause a significant decrease in plasma aldosterone levels.",
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-    "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.",
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-    "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.",
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-    "text": "Aldosterone elevation with suppressed renin levels identifies patients with potential primary aldosteronism.",
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-    "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.",
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-    "text": ", spontaneous hypokalemia with suppressed plasma renin activity and elevated plasma aldosterone concentration) may not require confirmatory testing.",
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-    "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.",
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-    "text": "This subtyping is accomplished with adrenal computed tomography and adrenal vein sampling.",
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-    "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.",
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-    "text": "Patients treated with adrenalectomy have reduced adverse cardiovascular outcomes and superior qualityoflife measures compared with patients who are managed medically.",
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-    "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.",
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-    "text": "For information about the SORT evidence rating system, go to https:// www.",
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-    "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.",
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-    "text": "High salt intake should cause physiologic suppression of the RAAS and a marked decrease in aldosterone levels.",
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-    "text": "A 24-hour urine collection is performed on the third day.",
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-    "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.",
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-    "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.",
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-    "text": "FLUDROCORTISONE TEST The fludrocortisone test involves administration of the synthetic mineralocorticoid fludrocortisone at a dosage of 0.",
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-    "text": "Exogenous mineralocorticoid administration should suppress serum aldosterone levels.",
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-    "text": "A plasma aldosterone concentration of greater than 6 ng per dL on day 4 confirms the diagnosis of primary aldosteronism.",
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-    "text": "Subtyping Once primary aldosteronism has been diagnosed, the next step is to determine if aldosterone production is unilateral or bilateral.",
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-    "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.",
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-    "text": "This differentiation, termed subtyping, is accomplished with adrenal computed tomography (CT) and adrenal vein sampling.",
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-    "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.",
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-    "text": "By assessing baseline nodule density, as well as contrast media uptake and subsequent washout, benign adenomas can be reliably distinguished from malignant masses.",
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-    "text": "20 CT has limited sensitivity for the detection of subcentimeter nodules.",
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-    "text": "Additionally, CT is unable to distinguish nonfunctioning adenomas from functioning adenomas.",
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-    "text": "A systematic review showed an almost 40% rate of discordance between CT and adrenal vein sampling in subtyping patients with primary aldosteronism.",
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-    "text": "21 Therefore, adrenal vein sampling is considered the preferred method of subtyping.",
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-    "text": "A systematic review and metaanalysis performed in 2022 found a statistically FIGURE 1 Suggested interpretation of initial case detection testing for primary aldosteronism.",
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-    "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).",
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-    "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.",
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-  {
-    "text": "Information from references 10,13, and 15.",
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-    "text": "Aldosteronerenin ratio Plasma renin activity > 1 ng per mL per hour Diagnosis unlikely Plasma renin activity 0.",
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-    "text": "6 to 1 ng per mL per hour Perform confirmatory testing Plasma renin activity < 0.",
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-    "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.",
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-    "text": "5 mEq per L Diagnosis confirmed Potassium  3.",
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-    "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.",
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-    "text": "18 Adrenal vein sampling is a nuanced procedure.",
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-    "text": "Blood samples are taken from a peripheral vein and the right and left adrenal veins and tested for aldosterone and cortisol levels.",
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-    "text": "22 Success rates for adequate sampling range from 30.",
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-    "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.",
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-    "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.",
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-    "text": "28,29 Treatment UNILATERAL ALDOSTERONE PRODUCTION Adrenalectomy is recommended in cases of unilateral aldosterone production.",
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-    "text": "Although hypertension is cured in only approximately onethird of cases, biochemical cure is achieved in 94% of cases.",
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-    "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.",
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-    "text": "32 BILATERAL ALDOSTERONE PRODUCTION When aldosterone production is bilateral, medical therapy is necessary.",
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-    "text": "Mineralocorticoid receptor antagonists are the cornerstone of therapy for patients with primary aldosteronism.",
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-    "text": "They are often used concurrently with other antihypertensives.",
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-    "text": "Dietary sodium restriction of less than 1,500 mg per day is recommended.",
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-    "text": "33 Spironolactone is a nonselective mineralocorticoid receptor antagonist and is the initial medication of choice.",
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-    "text": "5 to 25 mg per day and are increased, as needed, to a maximum dosage of 400 mg per day.",
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-    "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%).",
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-    "text": "34 If these adverse effects occur, eplerenone, a more selective but less potent and more expensive mineralocorticoid receptor blocker, may be used.",
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-    "text": "13,34 Recent observational studies have shown that titrating mineralocorticoid receptor antagonists based on plasma renin concentrations may lead to better outcomes.",
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-    "text": "35,36 Therefore, future guidelines may include interval measurements of renin as part of the mineralocorticoid receptor antagonist dosing strategy.",
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-    "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.",
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-    "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.",
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-    "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.",
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-    "text": "*Based on the 2016 Endocrine Society Guidelines.",
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-    "text": "Lowdose mineralocorticoid receptor antagonists may not need to be held before aldosteronerenin ratio testing, especially if renin levels are not suppressed.",
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-    "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.",
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-    "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.",
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-    "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.",
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-    "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.",
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-  {
-    "text": "org/afp American Family Physician 277 PRIMARY ALDOSTERONISM categories were assigned, they were excluded.",
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-  {
-    "text": "Physicians may need to exercise caution in applying such guidelines to populations not included (e.",
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-  {
-    "text": "Search dates: October 2,2022, and May 19,2023.",
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-  {
-    "text": "Monticone S, Burrello J, et al.",
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-    "text": "Brown JM, Siddiqui M, et al.",
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-    "text": "Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.",
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-    "text": "2021; 174(3): 289-297.",
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-    "text": "Jaffe G, Gray Z, et al.",
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-    "text": "Lim YY, Shen J, et al.",
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-  {
-    "text": "Curr Opin Endocrinol Diabetes Obes .",
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-    "text": "Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis.",
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-  },
-  {
-    "text": "Rosa J, Somlov Z, et al.",
-    "tokenCount": 11,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "6c819f174349efab043ef5babb4f19c161a311321e3d77e6d9861cc95083c0db"
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-    "text": "Peripheral arterial stiffness in primary aldosteronism.",
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-  },
-  {
-    "text": "Diagnosis and treatment of primary aldosteronism: practical clinical perspectives.",
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-    "pageEnd": 5,
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-  {
-    "text": "2019; 285(2): 126-148.",
-    "tokenCount": 10,
-    "pageStart": 5,
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-  },
-  {
-    "text": "Monticone S, DAscenzo F, et al.",
-    "tokenCount": 13,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "60fb68b3c60679715207676079d2cc7b4365674279124c37920eac8a37134ea1"
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-  },
-  {
-    "text": "Monticone S, Sconfienza E, et al.",
-    "tokenCount": 13,
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-    "pageEnd": 5,
-    "hash": "f85d13e5476ec723ee063347f4f389464c29e6cff8fb8ed05ca487ad8285547f"
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-  {
-    "text": "Funder JW, Carey RM, et al.",
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-    "text": "2016; 101(5): 1889-1916.",
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-  },
-  {
-    "text": "Rossi GP, Bernini G, et al.",
-    "tokenCount": 11,
-    "pageStart": 5,
-    "pageEnd": 5,
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-    "text": "A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.",
-    "tokenCount": 21,
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-  },
-  {
-    "text": "Kawashima J, Araki E, et al.",
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-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "9319df1d10803b8d0cc7927bd92c918721d57919ebf7863aebe381b7e2bffa4d"
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-    "text": "2020; 105(5): dgaa117.",
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-  },
-  {
-    "text": "Umakoshi H, Sakamoto R, et al.",
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-    "text": "2020; 105(4): dgz148.",
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-    "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.",
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-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "d20908c65fff97984e6a96e51a5e8c092e26166dde9d5605d48d7003c1f1680c"
-  },
-  {
-    "text": "Clin Endocrinol (Oxf) .",
-    "tokenCount": 10,
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-    "hash": "ad088ec201aea1b7dbc39832b4400541eb19b4849f9ade068b9b6f7576a2b951"
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-    "text": "2019; 90(5): 641-648.",
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-  {
-    "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) .",
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-    "hash": "678c82abc18bcf26f50be57b97fb170ce30cc36e82395e279d7c266ac7592407"
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-    "text": "2022; 24(2): 106-115.",
-    "tokenCount": 11,
-    "pageStart": 5,
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-    "hash": "659a89e14a4f824565eb6ac36bb387155c28e78ad8c9605c18bb8891a84dc0b8"
-  },
-  {
-    "text": "Lim V, Guo Q, et al.",
-    "tokenCount": 10,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "b7d274ed97021924f3b0c27626bf9612409db57e7bb05a65fd251a7320750c4a"
-  },
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-    "text": "Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism.",
-    "tokenCount": 24,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "18df92109e294d18757f92ab8d1d6377efa169f0d6ec621f90def155e0f68ac2"
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-    "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"
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-  {
-    "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"
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-    "text": "Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism.",
-    "tokenCount": 23,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "79c389242dc611a97e2476b20b6d231175b4e624b36822fd38ec9c36e88f4c3a"
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-    "text": "2009; 151(5): 329-337.",
-    "tokenCount": 10,
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-    "pageEnd": 5,
-    "hash": "077c82a36629164962d73dafcaaec2875222b30f319cd7232e5feeff526bcfe8"
-  },
-  {
-    "text": "Monroe EJ, Carney BW, et al.",
-    "tokenCount": 11,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "6a2886159cede572d87de2d453263d891c1163d0a289efe119892560bc5a1f0e"
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-    "text": "2017; 37(4): 1246-1267.",
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-  },
-  {
-    "text": "Vonend O, Ockenfels N, et al.",
-    "tokenCount": 14,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "f3cfc3ecc1b711d2401c024e89b428d9651b14960641fac2ea2c15faca27db24"
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-    "text": "Adrenal venous sampling: evaluation of the German Conns registry.",
-    "tokenCount": 15,
-    "pageStart": 5,
-    "pageEnd": 5,
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-    "tokenCount": 11,
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-    "hash": "a5385136a93cfdb2879b9259a4ebb6719184567ac538000becc15e35ce8845fe"
-  },
-  {
-    "text": "Ota H, Seiji K, et al.",
-    "tokenCount": 11,
-    "pageStart": 5,
-    "pageEnd": 5,
-    "hash": "72a72851744606370d1ad1d6b0498cbd5aee508cac8f4ed0edf39ec1d67f0ef0"
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-    "text": "Dynamic multidetector CT and noncontrastenhanced MR for right adrenal vein imaging: comparison with catheter venography in adrenal venous sampling.",
-    "tokenCount": 33,
-    "pageStart": 5,
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-    "text": "2016; 26(3): 622-630.",
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-  {
-    "text": "Tan MO, Puar THK, et al.",
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-    "text": "; Primary Aldosteronism Surgery Outcome (PASO) Investigators.",
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