| Computed tomography (CT) scanning is an integral component of 21 st-Century medical practice, and physicians have become increasingly reliant on this imaging modality for diagnosing disease and planning operative treatment. Following its introduction in the 1970s, CT scanning proved especially valuable for studying the organs of the abdominal cavity. However, with the rapid rise in the number of abdominal CT scans came an unanticipated problem: the identification of clinically silent adrenal tumors of unknown significance. The recognition of these asymptomatic, incidentally discovered adrenal tumors, dubbed "incidentalomas" by George Washington University surgeon Glenn Geelhoed in 1982, compelled physicians to embark on extensive hormonal workups, order further radiographic studies, and, in many cases, perform operations of questionable benefit.;In this paper I provide a historical analysis of adrenal incidentaloma from its initial recognition in 1982 until the National Institutes of Health-mandated consensus conference dedicated solely to its management in 2002. First, I explore the circumstances and historical context surrounding the early reports of adrenal incidentaloma, and describe how this entity received its name. Next, I trace the efforts of three separate classes of physicians (endocrinologists, radiologists, and surgeons) to characterize these tumors and formulate rational guidelines for their treatment. Finally, I reflect upon the impact that adrenal incidentaloma has made upon medical thought and practice during its relatively short existence. Throughout this paper I show how adrenal incidentaloma has transformed the traditional diagnostic algorithms of adrenal disease, altered definitions of illness and wellness in subtle but significant ways, and forced physicians to come to terms with uncertainty in a practice environment that increasingly expects them to provide unassailable, error-free care. |
