Adrenal nodule

Chief Complaint

Adrenal nodule

Template

Thank you for referring [name], a [age] year old [gender], for assessment of an adrenal nodule. Consent: I obtained consent from the patient for use of an AI scribe software. I explained that Empathia saves a copy of our conversation on their website for the purpose of generating a note, and that this software is FDA approved. History of Presenting Illness: Symptoms of Cushing's syndrome: [abdominal striae, weight gain, skin thinning, easy bruising, facial plethora, weight redistribution, proximal muscle weakness, osteoporosis/fractures, hirsutism, VTE, hypertension, hyperglycemia] Symptoms of pheochromocytoma: [paroxysms of flushing, headache, sweating, pallor, tremors, anxiety, palpitations, chest pain, dyspnea] Symptoms of hyperaldosteronism: [hypertension, hypokalemia] Symptoms of hyperandrogenism: [hirsutism, clitoromegaly, voice deepening, increased musculature, male pattern baldness, irritability] B-symptoms: Medical history: [medical_history] (List numerically with each having its own line) Medications: [medications] (List numerically with each having its own line) [Exogenous steroids] [Medications that will affect testing] Allergies: [allergies] (List numerically with each having its own line) Social history: Work: [work] Extended coverage: [coverage] Alcohol: [alcohol] Cigarettes: [cigarettes] Drugs: [drugs] Family history: [family_history] There [is/is no] family history of [adrenal tumors, pituitary tumors, pancreatic tumors, medullary thyroid cancer, or other malignancies]. Exam: [exam] Weight: [weight] Height: [height] Blood pressure: [blood_pressure] Heart rate: [heart_rate] [Stigmata of Cushing's: the patient had/did not have abdominal striae, facial plethora, dorsocervical fat pad, supraclavicular fullness, skin thinning, hirsutism] [Proximal muscle strength] [Stigmata of hyperandrogenism: the patient had/did not have increased musculature, male pattern baldness, hirsutism] Investigations: [investigations] (List each investigation in its own line, not numerical, and arrange by date of investigation) [24 hour urine collection, with volume] [MR sella] Impression and Plan: [name] is a [age] [gender] with an adrenal nodule. The differential includes nonfunctional adrenal adenoma, functional adrenal adenoma, pheochromocytoma, primary bilateral adrenal nodular hyperplasia, adrenal metastases 1. Adrenal nodule: (List detailed action plans using the correct person tone, e.g., 'I have started [medication] for diabetes control' or 'The family doctor has initiated...) - I have provided a requisition for [24 hour urine metanephrines and catecholamines] [24 hour urine cortisol or 1mg dexamethasone suppression test or late night salivary cortisol] [- I have provided a requisition for an aldosterone to renin ratio] [- I have provided a requisition for LH, FSH, testosterone, DHEAS, estradiol] [- I have sent a requisition for CT adrenals] [- Given the degree of cortisol elevation, I have initiated DVTp/PJP prophylaxis] [- I recommend a repeat CT adrenals in 6 months or 12 months or 24 months] Thank you for involving me in the care of this pleasant patient. Please do not hesitate to contact me with any questions or concerns. Dr. Leo Hu, MD, FRCPC [clinic]