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Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism. Clin Endocrinol (Oxf) . 2018;88(5):645-651. The Journal of Clinical Endocrinology & Metabolism , 2025, Vol. 110, No.
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role of metanephr - ine in adrenal vein sampling. J Clin Endocrinol Metab . 2023; 108(9):e720-e725. Dekkers T, Deinum J, Schultzekool LJ, et al. Plasma metanephrine for assessing the selectivity of adrenal venous sampling. Hypertension . 2013;62(6):1152-1157. Ueland G, Methlie P, Jøssang DE, et al. Adrenal venous sampl...
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48ceaf1afcfe61d6da75a41cef94977e368aaa580d9a6c3136d24485a51c881e
Comparison of corti - sol, androstenedione and metanephrines to assess selectivity and lateralization of adrenal vein sampling in primary aldosteronism. J Clin Med . 2021;10(20):4755. 2494 The Journal of Clinical Endocrinology & Metabolism , 2025, Vol. 110, No.
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Accurate location of catheter tip with the free-to-total metanephrine ratio during adrenal vein sampling. Front Endocrinol (Lausanne) . 2022;13:842968. Heinrich DA, Quinkler M, Adolf C, et al.
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Influence of cortisol co - secretion on non-ACTH-stimulated adrenal venous sampling in primary aldosteronism: a retrospective cohort study. Eur J Endocrinol . 2022;187(5):637-650.
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6919540bfe42e919d4fdad95ca96827bf9730a28e05b011d73179b894f56992a
Karagiannis A, Tziomalos K, Papageorgiou A, Kakafika AI, Pagourelias ED, Anagnostis P, Athyros VG, Mikhailidis DP.
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b6490e9edbfd476bac2d0ebf8ed7734c924bd7ce3d4c2d5fd078f82571654206
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a34fca36831cc9b0d64058cdb6b9b102464bca9a5948d2e2197b646709be80e3
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d350dcd13c67deaee2f398fbc3add771c0c4edb1673f2e61cc660ebe46f60be5
Efficacy and safety of finerenone in pa - tients with primary aldosteronism: a pilot randomized controlled trial. Circulation . 2025;151(2):196-198.
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a89f5cec8ee97cb475af333b27c438d8bee2bcdc050e4b42384c688fab200665
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95fc6bd3545ce0779231de397d33376acd6c30a1124229cc62252fe18d77b064
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1841805c8e1096dba78746c1c2b7c4ecd0611f55ee55667547f4853000606d63
The spironolac - tone, amiloride, losartan, and thiazide (SALT) double-blind crossover trial in patients with low-renin hypertension and elevated aldosterone-renin ratio.
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9 2495 Downloaded from https://academic.oup.com/jcem/article/110/9/2453/8196671 by University of Wisconsin System user on 20 February 2026
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269f575bf26f249851ceaeb2625d1c4ac078ad29c4508e6f642d8217db0c3b8f
categorizing clinical notes using our established themes with the ability to create new classifications if necessary. Following completion, we again reviewed our results as a team to finalize our results. All statistical analyses were performed with SAS software.
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A bivariate analysis was performed using chi-squared and Student’s t-test analysis. Multivariate logistic regression was performed to evaluate factors associated with biochemical workup. Results Study cohort During the study period, 9022 patients had a qualifying CT scan performed and 533 (5.9%) individuals with IAMs w...
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48e6d284db8724a0d7cfccb4485df7f221e2fe8d996c7a2552615e5580283175
After applying exclusion criteria, 245 (46.0%) of 533 patients were included in our final analysis ( Fig. Demographics Overall, the final patient cohort was 58.8% female, 58.0% over 65 y of age, and 86.1% White ( Table 1 ).
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b03d62fdae2ccbf0412688febb834c1f73df27df25d68e82297eaa561a979ac9
The patient population was generally healthy with 50.6% reporting a CCI of 0 or 1. Most patients were covered by Medicare (49.0%) or private insurance (43.3%). The most common ADI deciles were 4 or 5, making up 17.0% and 17.4% respectively.
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89d0bc4bac06fee3b5115403a704fad91beeb33c047bd4dc42daa5ad2b49c191
A total of 135 pa- tients (56.0%) were from advantaged neighborhoods (lower 50th percentile ADI). Imaging and ordering provider characteristics The majority of the imaging which discovered the IAM was ordered by EM providers (50.6%), followed by subspecialists (36.7%), and PCPs (12.7%).
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A total of 77.1% of ordering providers were physicians, while the remainder were physician assis- tants or nurse practitioners. The vast majority of the CTs or- dered were with contrast (93.1%).
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Rate of IAM workup Most (71%) IAM patients received no further workup, 18% had partialevaluation,and11%hadfullassessment( Fig. A chi-square test revealed statistically significant associations between sex, neighborhood disadvantage, and ordering provider with IAM workup.
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More specifically, female (71.8% versus 28.2% males, P < 0.01) and advantaged (67.1% versus 32.9% disadvantaged, P ¼ 0.03) 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 (54.6% rec...
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Among advan- taged patients, 54.8% had scans ordered by EM providers and 17.8% had scans ordered by PCPs ( Table 2 ). Of the disadvan- taged patients, scans ordered by EM providers and PCPs were 45.3% and 6.6%, respectively.
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Comparison of patients who hadapartialorfullworkupispresentedin Supplementary Table 1 . Factors associated with biochemical evaluation Logistic regression demonstrated disadvantaged patients were less likely to undergo any workup compared to advan- taged patients (odds ratio [OR] 0.51, confidence interval [CI] 0.26-0.9...
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Other factors significantly associated with receiving any workup included female sex (OR 2.26, CI 1.19- 4.31) and scans ordered by PCPs (OR 4.08, CI 1.69-9.81) compared to EM providers.
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There was no statistically signifi- cant difference in workup based on age, race, ethnicity, in- surance status, or CCI. 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 eval...
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The most common theme of missed evaluation related to radiology reports recom- mending no further workup. 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 biochemi...
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For instance, a communi- cation 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.
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Second most common was PCPs not acknowledging the nodule nor ordering additional tests, suggesting these incidental findings were missed. Lastly, Fig. 1 e Included patients flowchart. o’connor et al  adrenal incidentaloma management 145
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patients were frequently lost to follow-up after imaging and never completed biochemical testing when recommended. Discussion In our study, the rates of complete guideline-concordant biochemical workup or partial evaluations of adrenal inci- dentalomas were 11% and 18%, respectively.
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d2359f4e3b7e9127bcdb50c0d6b8a9a4a2cb535982aa032e6055d4a5b8669b4a
These alarmingly low rates align with other publications, confirming absent or incomplete IAM evaluations are commonplace. 2 , 12 , 20 For instance, Ebbehoj et al . (2020) reported appropriate workup of IAMs was completed in only 15.2% of cases.
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b2326c8ace3a63436b4e4d77ba350e221015f98eaaaf9d60d2f7aec813915314
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. 10 , 11 , 21 Workup rates were particularly low for patients living in disadvantaged neighborhoods.
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2a1d88d0c9f7d3feefc15da5a0da8e6f6ec866a57787bfbb023c33c7fc377f35
We found patients from these neighborhoods had roughly half the odds of obtaining any IAM workup compared to those from advantaged neighbor- hoods. Our findings are consistent with literature linking neighborhood-level disadvantage with poorer health out- comes and disease management.
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22 , 23 Similarly, Schut and Mortani Barbosa (2020) reported racial/ethnic disparities in incidental pulmonary nodule management. 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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c4ae76e15872f63c0215cbbba46417a7fc3d09eb7d0022ffffbca08cc2135db2
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. 23 , 27 Furthermore, our secondary chart analysis revealed lack of follow-up as a common theme among patients in disadvantaged neighborhoods, r...
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No workup (n ¼ 174) % Any workup (n ¼ 71) % Total cohort (n ¼ 245) % P value Sex < 0.01 Female 53.5 71.8 58.8 Male 46.5 28.2 41.2 Age 0.10 < 65 54.6 66.2 58.0 > 65 45.4 33.8 42.0 Race/Ethnicity 0.68 White 86.2 85.9 86.1 Black 5.2 7.0 5.7 Hispanic 2.9 4.2 3.3 Asian 3.5 2.8 3.3 Other/Unknown 2.3 0.0 1.6 CCI 0.96 0 22.4 2...
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primary care and navigate the health-care system. Addition- ally, clinics serving disadvantaged patients typically have limited resources, and as a result, prioritization of other ur- gent health matters may supersede evaluation of incidentalomas.
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28 While our study demonstrated poor IAM workup compli- ance across all medical/surgical fields, investigations were significantly lower when diagnoses were established during ED visits. Similarly, Feeney et al .
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d5428d6cc76b6a5e12431054dfe08dd1f0acf77bc9dd5364a2fcabff5f6fd76a
(2020) reported a three-fold lower rate of follow-up imaging if the index study was per- formed while the individual was an inpatient or in the ED compared to outpatient. 29 Interestingly, several previous publications focused on poor IAM workup compliance in pri- mary care outpatient settings.
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30 , 31 The authors suggested PCPs may lack time and/or knowledge of appropriate biochemical evaluations to adequately address IAMs. However, our study suggests the emergency room as a potentially larger source of missed IAM management.
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Although disadvantaged patients had higher rates of detection by EM providers, ordering pro- vider remained a significant factor even when controlling for socioeconomic deprivation. Our chart review noted PCPs failing to acknowledge the nodule as a major reason for missed workup, and suggests that communication between...
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One strategy to improve coordination of care is the develop- ment 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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A recent study utilized artificial in- telligence 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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Another problem contributing to incomplete IAM evalua- tion is radiologists recommending no further workup. 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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To combat the issue, the use of radiology reporting templates which encourage addi- tional testing and provide specific follow-up recommenda- tions have led to increased rates of follow-up imaging and biochemical testing.
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33-35 While modifications to radiology reporting language (e.g., low concern for malignancy, could consider a functional workup) are a step in the right direction, additional protocols and interdisciplinary teams are neces- sary to ensure even more patients are adequately evaluated.
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Recently, a program combining standardized radiologic reporting, chart-based 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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36 Similarly, interdisciplinary collaboration between radiologists, EM physicians, nurse case managers, and PCPs resulted in 95% of ED patients with incidental radi- ology findings having follow-up plans for evaluation after discharge.
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