ABSTRACT
Metastases to the adrenal gland are more common than primary adrenocortical carcinoma. Such metastases tend to originate from pulmonary, renal, mammary, and gastrointestinal carcinomas (3). Adrenal metastasis has been noted in 10% to 27% of autopsies of patients with known malignancy (4,5). Patients with metastasis to the adrenal gland commonly have disseminated cancer. Rarely does the clinician diagnose a patient suspected of harboring an isolated adrenal metastasis. The management of such a patient presents a challenging dilemma. Having already undergone definitive treatment for the primary malignancy, the physician is faced with counseling the patient on the best treatment strategy for the presumed metastasis. Unfortunately, the treatment of such lesions is controversial. Although some reports support the surgical treatment of isolated adrenal metastases with long-term survivors, identifying the most suitable surgical candidate is less clear. The ideal study would involve a prospective comparison of patients with adrenal metastasis randomized to receive surgical treatment or observation or another form of treatment (chemotherapy/radiation). However, the accrual period of such a study would be extraordinarily long given the rare subset of patients in question. As such, clinical decisions must rely on larger retrospective studies, addressing a heterogeneous group of patients with a wide array of primary malignancies that have metastasized to the adrenal gland.
