Adrenal incidentaloma - how much do y'all work it up in the hospital?

[SuckySurgeon7]

Question for hospitalists out there. CT imaging so often shows an adrenal incidentaloma. I see various practices regarding what is done, and I'm wondering what y'all's practices are.
1) Rule out hormonal activity in the hospital (aldosterone renin ratio, dexamethasone overnight suppression test, or assess metanephrines) before discharge.

2) Order repeat imaging but defer hormonal evaluation to outpatient setting

3) Defer hormonal evaluation and repeat imaging to the outpatient follow up visit but make a note of it on the discharge summary and tell patient to follow up

The question was prompted by a recent review of guidelines for incidentalomas and noticing that the European recommendations seem to urge a more immediate evaluation of incidentalomas, including the hormonal evaluation.

Thanks in advance.

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[DrMetal]

Question for hospitalists out there. CT imaging so often shows an adrenal incidentaloma. I see various practices regarding what is done, and I'm wondering what y'all's practices are.
1) Rule out hormonal activity in the hospital (aldosterone renin ratio, dexamethasone overnight suppression test, or assess metanephrines) before discharge.

2) Order repeat imaging but defer hormonal evaluation to outpatient setting

3) Defer hormonal evaluation and repeat imaging to the outpatient follow up visit but make a note of it on the discharge summary and tell patient to follow up

The question was prompted by a recent review of guidelines for incidentalomas and noticing that the European recommendations seem to urge a more immediate evaluation of incidentalomas, including the hormonal evaluation.

Thanks in advance.

Almost always, option #3. You're not likely to follow up with the labs, so best to defer to the outpatient setting.

 

[NewYorkDoctors]

in general I tell residents and fellows do not order "special" labs that are usually done outpatient unless you plan to follow it up in clinic yourself or you take the effort to make sure it gets to the PCP (or better yet the appropriate other subspecialist). otherwise it's a wasted lab that no one follows up on. Plus it might be more expensive getting it done inpatient than outpatient.

still it behooves the the primary team to ensure the PCP gets the discharge note and the relevant reports. a phone call to PCP is nice but not all PCPs pick up the phone....

 

[rokshana]

Question for hospitalists out there. CT imaging so often shows an adrenal incidentaloma. I see various practices regarding what is done, and I'm wondering what y'all's practices are.
1) Rule out hormonal activity in the hospital (aldosterone renin ratio, dexamethasone overnight suppression test, or assess metanephrines) before discharge.

2) Order repeat imaging but defer hormonal evaluation to outpatient setting

3) Defer hormonal evaluation and repeat imaging to the outpatient follow up visit but make a note of it on the discharge summary and tell patient to follow up

The question was prompted by a recent review of guidelines for incidentalomas and noticing that the European recommendations seem to urge a more immediate evaluation of incidentalomas, including the hormonal evaluation.

Thanks in advance.

endocrine here...and dont do any hormonal studies while they are critically ill...those labs mostly likely won't be accurate and may lead you down the wrong path...as an endocrinologist, i'll be repeating all those labs when they are back to their baseline and really put no stock in the labs done in the hospital while the pt was sick...so rarely helpful.

if the CT scan was done without contrast, then the radiologist can generally comment on the Hounsefeld Units and it gives info if further testing will be needed (HU <10 and its a benign adenoma...100% sensitivity...no further testing for malignancy/pheo needed BTW). If done with contrast, could consider getting CT with adrenal protocol while inpt, but wouldn't keep inpt to do so.

biggest thing is to get pt endocrine as output for further evaluation (if imaging consistent with a pheo or malignancy, then would get inpt consult if you have that or urgent output referral) since 70% of adrenal incidentalomas found inpt, dont get further evaluation.