From detection to diagnosis: Early outcomes of a specialized adrenal nodule clinic.

Abstract

With the rise in cross-sectional imaging, adrenal incidentalomas are increasingly detected. However, adherence to recommended biochemical evaluation remains low. To improve the evaluation and management of adrenal nodules, we implemented a multicomponent intervention incorporating standardized radiology reporting, an electronic health record-embedded adrenal nodule order set, and a specialized adrenal clinic. This study evaluates early clinical outcomes following implementation. Patients referred to a specialized adrenal clinic between June 1, 2024 and October 31, 2025 were evaluated. Referrals were triggered by standardized radiologic identification of an adrenal nodule and reference to an adrenal nodule order set. The order set initiated biochemical testing and clinic referral. The primary outcome was the completion of biochemical evaluation. Secondary outcomes included follow-up, diagnostic evaluation, and surgical intervention. During the study period, 301 patients were referred, and 130 patients completed a clinic visit. Initial biochemical evaluation was completed in 117 patients (90%). Ninety-two patients underwent confirmatory testing, revealing that 72 (73.5%) had nonfunctional adenomas and 20 (20.4%) had hormonally active disease, including primary aldosteronism (11.2%), mild autonomous cortisol secretion (7.1%), and pheochromocytoma (2.0%). Thirteen patients were referred for surgical evaluation, of whom 8 (61.5%) underwent adrenalectomy. Implementation of a standardized adrenal incidentaloma evaluation pathway incorporating radiology templating, electronic health record-embedded ordering, and a specialized adrenal clinic was associated with improved completion of biochemical testing and identification of significant disease. Multilevel health-system interventions may bridge the evidence-to-practice gap in the management of adrenal incidentalomas and facilitate the identification of surgically actionable lesions.