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Hormonal evaluation is recommended for all IAMs. The purpose of this study was to identify the rate of IAMs in a screening population and to determine the adequacy of endocrine evaluation of newly identified IAMs based on established guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective analysis of 6913 patients undergoing a non\u2010contrast screening CT colonography at a single academic medical center between June 2004 and July 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of IAMs in this asymptomatic screening population was 2.1% (<jats:italic>n<\/jats:italic>\u2009=\u2009148). Of those patients, 8.8% (<jats:italic>n<\/jats:italic>\u2009=\u200911) underwent some form of hormonal evaluation and only 6.4% (<jats:italic>n<\/jats:italic>\u2009=\u20098) patients had a \u201ccomplete\u201d workup. Cortisol, metanephrines, and an aldosterone\u2013renin ratio were evaluated in 8.0%, 7.2%, and 4.0% of patients, respectively. Of the patients (<jats:italic>n<\/jats:italic>\u2009=\u200911) who underwent hormonal evaluation, 27.3% had functional masses and 36.4% underwent surgery. Of those who did not have hormonal evaluation, 42.1% (<jats:italic>n<\/jats:italic>\u2009=\u200948) had comorbidities that should have prompted hormonal evaluation based on established guidelines. Hormonal evaluation was not performed in 89.4% of patients with hypertension and 21.1% of patients with diabetes. 88.9% of patients on three or more antihypertensive medications did not undergo any hormonal evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compliance with IAM workup guidelines is poor, which may result in missed diagnosis of functional adrenal masses. Establishment of a robust protocol and education on appropriate workup for IAMs is necessary for adequate hormonal evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05679-9","type":"journal-article","created":{"date-parts":[[2020,7,10]],"date-time":"2020-07-10T14:04:11Z","timestamp":1594389851000},"page":"3778-3785","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hormonal Evaluation of Incidental Adrenal Masses: The Exception, Not the Rule"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2324-844X","authenticated-orcid":false,"given":"Michael J.","family":"Kirsch","sequence":"first","affiliation":[{"name":"Department of Surgery University of Colorado Aurora CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun\u2010Tai","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, 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