[aantix]

Benign adrenal adenoma.

From the pathology report:

"Representative sections predominantly consist of a normal adrenal gland with intermixed adrenocortical tissue and medulla. A distinct nodular area is present with prominent foamy-type clear cytoplasm reminiscent of normal adrenocortical tissue. No significant cytologic atypia, necrosis, or increased mitotic activity is present. These findings are consistent with an adrenocortical adenoma. Note: this area appears to be limited to the adrenal gland although some adrenocortical tissue is present in the adipose tissue outside the capsule that morphologically appears dissimilar to the nodule and likely represents normal/benign tissue. Clinical correlation recommended."

[riahi]

Tough case. Adrenal adenomas are common incidental findings. ~15% are hormonally active, which means the vast majority are not.

As a radiologist, I sometimes wonder about whether I make too many recommendations to referring doctors (consider endocrine evaluation for a potentially hormonally active adrenal nodule).

A FREQUENT attack on us as a specialty is that we "find too many incidentals" (see attacks on mammography, breast cancer screening, other sorts of screening, ad nauseam).

Perhaps I'll keep doing the adrenal nodule recommendation, although I usually only make the recommendation if it's 1cm or larger.

[aantix]

I could see that if you're evaluating just the imaging, that's a hard call.

Are you provided these details as well?

* Hypertension 20+ years

* Resistant hypertension - four medications with one being a diuretic.

* Early onset hypertension (high school)

* Low potassium

Coupled with the history, Hyperaldosteronism seems much more probable.

There are a ton edge cases/conditions to keep in one's head. I'm sure that's a problem in all domains, definitely medicine.

I wish it could be a multidisciplinary team decision. But then it would become an issue of reaching consensus. And probably too expensive.

[riahi]

Sometimes we have the clinical context, usually if practicing in a large hospital system with an integrated EMR. It's not usually so neatly summarized though; maybe if we are lucky we can quickly glance through relevant notes at the time of scan interpretation.

However, healthcare in the US is very fragmented. Many patients seek cheaper imaging at freestanding imaging centers. Those places often don't have the same HIT integrations to have similar medical context.

And in those settings, I only know what's on the images and maybe 200-300 characters on the "reason for study" box.

This is not to say I think everyone should get scanned at expensive sites; more an indictment on how annoying the current EMR situation is.