New research shows that adrenal nodules not being adequately evaluated

Jul 2 2008

A new study published in Endocrine Practice found that a substantial percentage of patients with nodules, or growths, in their adrenal glands were not being properly evaluated by physicians.

Adrenal glands are located at the top of each kidney. They make hormones that are critical for survival such as adrenaline and cortisol that are best known for dealing with stress.

The study, lead by Dr. Leslie Eldeiry, a clinical instructor at Harvard Medical School, which was conducted at Harvard Vanguard Medical Associates, found that "only 30 percent of patients underwent biochemical evaluation for adrenal hyperfunction," which is the production of excessive amounts of hormone.

The adrenal nodules which were studied are commonly referred to as "incidentalomas" because they are discovered by chance as a result of testing for other conditions. Incidentalomas are very common and are seen in 8 to 10 % of CT scans of the abdomen. In 2002, the National Institutes of Health released guidelines recommending hormonal evaluation of all incidentally discovered adrenal masses. Despite the 2002 NIH recommendations, only 30 percent of patients were properly tested. Moreover only 18 percent of patients in the study who did not see an endocrinologist with adrenal nodules had hormonal testing.

"The report is a test of the standard of practice in the general medical community in the setting of guidelines that outline recommended medical care," Robert G. Dluhy, MD, a professor at Harvard Medical School and member of the Brigham and Women’s Hospital division of Endocrinology, Diabetes and Hypertension, said in an accompanying editorial. "This study is alarming because even though the great majority of 'incidentalomas' are benign and do not produce hormones which cause illness, a fraction will have disorders that could be life-threatening."

"This report should send a strong message to the endocrine community," he said. "We need to do a better job of educating internists and physicians about the proper hormonal evaluation of these adenomas coupled with periodic imaging to insure that the tumor is very unlikely to be a malignancy."

About AACE

AACE is a professional medical organization with more than 6,000 members in the United States and 84 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine disease, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.