Giles W. L. Boland
Much has changed since Addison's quip in 1855. Despite its small size, the adrenal gland can harbor myriad abnormalities ranging from hormonal dysfunction, to primary and secondary neoplasia, to infiltrative disease. Before the advent of contemporary cross-sectional imaging, the diagnosis of many of these diseases remained elusive, often only to be discovered at autopsy. However, with the increasing use of cross-sectional imaging to investigate a whole host of abdominal diseases, the law of unintended conse¬quences is revealed.We are now challenged with the opposite problem—adrenal gland abnormalities are being detected all the time, most a source of little or no concern but others potentially fatal, leaving physicians frustrated to know which is which. Depending on the age of the patient (more common when older), adrenal gland abnormalities are observed in up to 5-8% of patients undergoing CT, equating to hundreds of thousands of adrenal masses being detected each year in the United States alone [1].