The impact of an adrenal incidentaloma algorithm on the evaluation of adrenal nodules.

OBJECTIVE: To determine the impact of the use of an electronic medical record tool on the evaluation of adrenal incidentalomas. METHODS: Retrospective chart review was used to compare rates of hormone testing and follow up imaging for adrenal incidentalomas. Patients whose radiology reports contained an algorithm with recommendations, based on our 2013 clinical guideline for the workup of these nodules, were compared to those whose imaging reports did not contain the algorithm. RESULTS: For patients whose Radiology reports contained the algorithm, 69% had hormonal testing versus 43% of controls (p < 0.0001). By contrast, 57% of study group patients had a follow up imaging study, compared to 51% of controls (p = 0.1000). However, when the 18% of controls that were given guidance by the radiologist to perform follow-up imaging were excluded from those who received no guidance, there was a statistically significant difference in the rate of follow up imaging (57% vs 48%, p < 0.0001). CONCLUSION: Implementation of a clinical algorithm for the evaluation of adrenal incidentalomas in radiology reports and on the intranet site of a major clinical center led to improved rates of hormone testing. There was also a significant increase in the rate of follow up imaging, compared to when no guidance was given. Additional efforts to further improve performance are needed to increase the detection of clinically significant lesions, particularly hormone secreting tumors that should be removed.

Atypical Peters plus syndrome with new associations.

Peters plus syndrome is a rare condition, with ocular and systemic malformations. We describe a case of unilateral Peters anomaly with previously unreported systemic findings associated with this syndrome. In addition, autopsy findings suggested that severe developmental angle anomalies may be the cause of glaucoma in some of these patients.