SAT-457 Are Adrenal Incidentalomas Being Appropriately Worked Up?

Abstract Disclosure: A. Saif: None. F. Alghzawi: None. R. Luitel: None. L. Suboh: None. P.R. Schroeder: None. Introduction: Adrenal incidentalomas are defined as masses that are discovered incidentally on imaging done for non-adrenal disorders. Guidelines from the American Association of Clinical Endocrinologists (AACE), American Association of Endocrine Surgeons (AAES), and European Society of Endocrinology recommend that all patients found to have an incidental adrenal mass undergo clinical, biochemical, and radiographic evaluation. We hypothesize that incidentally found adrenal nodules on abdominal imaging are not being appropriately tested for hormone production according to the guidelines, especially by primary care providers in our health system. Methods: We conducted a retrospective chart review of 229 patients with ICD-10 codes E27.9 (adrenal nodule), I1A.0 (resistant hypertension), E24.9 (features of Cushing syndrome), E87.6 (hypokalemia), and L68.0 (hirsutism) admitted to the general medicine units or seen in any of the internal medicine, family medicine, and endocrine clinics, including the resident teaching clinics at MedStar Health from the period of July 2019-June 2024. After exclusions, 155 charts were analyzed.The primary outcome was to determine the percentage of patients with adrenal nodules who underwent complete initial screening work up and to assess the difference when the patient was seen by an endocrinologist. As per guidelines, completed screening work up included: 1) 1 mg overnight dexamethasone suppression test for cortisol excess, 2) plasma aldosterone concentration and renin activity level for hyperaldosteronism in patients with hypertension or unexplained hypokalemia, and 3) plasma free metanephrines or urinary fractionated metanephrines for pheochromocytoma if the unenhanced computerized tomography (CT) attenuation was >10 Hounsfield Units (HU). Results: Of the 155 charts reviewed, 30% had complete work up when endocrinology was involved vs 4.8 % when endocrinology was not consulted in the hospital. In the outpatient setting, 70% of patients had complete adrenal nodule work up when they were seen by an endocrinologist vs 12.5% among patients seen by primary care providers. Interestingly, we also found that 22 patients had am cortisol measured instead of the recommended tests for screening Cushing’s syndrome. Conclusion: As hypothesized, a significantly lower number of patients underwent complete adrenal nodule work up when they were not seen by an endocrinologist. Often workup was started but either not complete or an incorrect test was ordered. While our study highlights the significance of timely endocrinologist involvement in adrenal nodule work up, it also shows the need for more education for primary care providers regarding the proper evaluation of incidental adrenal nodules. Presentation: Saturday, July 12, 2025