Most incidentally found adrenal tumors are nonfunctioning, regardless of patient age

1. Most incidentally found adrenal tumors are nonfunctioning, regardless of patient age
Abstract: https://www.acpjournals.org/doi/10.7326/M22-1619
Editorial: https://www.acpjournals.org/doi/10.7326/M22-2600
URLs go live when the embargo lifts
A cross-sectional study of more than 25,000 adults has found that with increased screening, the prevalence of adrenal tumors in an unselected community population was 1.4%. The prevalence increased with age, from 0.2% in adults aged 18 to 25 up to 3.2% in adults older than 65 years of age. However, approximately 70% of identified tumors were nonfunctioning, meaning they did not make extra hormones, regardless of the participant’s age. The findings are published in Annals of Internal Medicine.

The detection rate of adrenal incidentaloma, or an incidentally found nodule not causing clinical symptoms, has increased as screening techniques have improved and become more common. However, most published literature on the prevalence of adrenal incidentalomas consists of retrospective surveys based on radiographic diagnosis in a medical record system, which might under- or overestimate the prevalence.

Researchers from the First Affiliated Hospital of Chongqing Medical University, Chongqing, China, conducted a cross-sectional study of 25,356 participants receiving annual health assessments between November 2020 and November 2021. The authors report that of all 25,356 participants, 351 persons were identified as having adrenal tumors. Of these, 337 participants with adrenal tumors were diagnosed with an adrenocortical adenoma and 14 were diagnosed with another benign nodule. No participants were diagnosed with having a malignant mass. The authors also report that of 212 participants who completed endocrine testing, 69.3% were diagnosed with a nonfunctioning adenoma, 18.9% with cortisol autonomy, 11.8% with primary aldosteronism, and no participants were diagnosed with pheochromocytoma.

An accompanying editorial from Mayo Clinic highlights how this research provides important insights into the prevalence of adrenal tumors and supports current recommendations for universal hormonal testing in any patient with an incidentally found adrenal tumor. However, the author cautions that the study is limited by the lack of hormonal testing in 37% of participants, particularly because persons who declined hormonal work-up were older and more likely to have hypertension. As such, both mild autonomous cortisol secretion and primary aldosteronism could have been more prevalent in this group.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org.
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2. S-Elixhauser comorbidity score may not be more advantageous than other summary scores for predicting in-hospital and long-term mortality
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4204
URL goes live when the embargo lifts
A cohort study from Johns Hopkins Bloomberg School of Public Health has found that the newly developed summary Elixhauser (S-Elixhauser) comorbidity score is well calibrated and internally validated to predict in-hospital, 30-day, and 1-year mortality but its advantage over the existing Agency for Healthcare Research and Quality (AHRQ) Elixhauser and Charlson summary scores is unclear. The report is published in Annals of Internal Medicine.

Summary comorbidity scores, such as the Charlson comorbidity index and the Elixhauser comorbidity index, can both describe comorbidity burden in observational studies and be used for prognosis. The set of Elixhauser comorbidity indicators was developed in 1998 but has undergone modifications, including the addition of weighted scores and expanded comorbidity codes. AHRQ also derived and evaluated the model fit of a summary Elixhauser score, based on weighting the individual comorbidities, to predict in-hospital mortality and 30-day all-cause readmissions in hospitalized adults. However, the performance of the summary score has not previously been evaluated for predicting longer-term mortality outcomes, nor has it been validated for use in older adults.

Researchers studied data from Medicare beneficiaries hospitalized in 2018, including those discharged with diagnoses of heart failure, chronic obstructive pulmonary disease, or diabetes. The authors derived weights to calculate the S-Elixhauser comorbidity score for in-hospital, 30-day, and 1-year mortality. The score was then internally validated and calibrated for short- and long-term mortality outcomes among all older adults and those who were hospitalized for the three specified diagnoses. The authors also performed an external validation of Charlson and AHRQ Elixhauser comorbidity scores in predicting mortality among older adults. According to the authors, the internally validated S-Elixhauser discrimination measures were minimally better than the externally validated measures from the other scores, a difference that they expect to diminish or disappear when there is external validation of S-Elixhauser.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Hemalkumar B. Mehta, PhD, please email JHMedia@jhmi.edu.
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3. Harvard researchers present 4-step framework to increase voter turnout among medical professionals
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2168
URL goes live when the embargo lifts
Over the past 2 decades, medical professionals voted about 20% less often than the general population. When asked why they did not vote, physicians often cited busy schedules, lack of voter registration, and feeling that their individual vote did not matter. To remedy this issue, a team of researchers from Harvard Medical School and UT Southwestern Medical Center developed a 4-step framework to increase voter turnout among medical professionals, with specific actions that individuals and health systems can take. The Framework is published in Annals of Internal Medicine.

According to the researchers, it’s important for medical professionals to vote because health policy set be elected officials directly affects their profession and the patients they serve. The authors say 4 steps are crucial for mobilizing medical professionals to vote: registration, which entails encouraging and helping medical professionals register to vote in their district; non-partisan education, to understand the issues and where the candidates stand on them; communication between friends and family to plan when and where to vote while adding social accountability; and simplification, to address common barriers to voting like time off to vote.

The researchers provide detailed actions for how individuals and health systems can engage in each of these 4-steps. They believe that adopting their simple 4-step framework can help to reinvigorate civic engagement among medical professionals so they can more easily voice their opinions about key health policy matters.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Hussain S. Lalani, MD, MPH, please email hlalani@bwh.harvard.edu.
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Deep Venous Thrombosis
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Article: https://www.acpjournals.org/doi/10.7326/M22-1364