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Adrenal metastases

The adrenal gland is a common site for cancer to spread. Lung cancer, kidney cancer, melanoma and breast cancer are the usual primary sources. Not every adrenal metastasis is treated surgically, but in carefully selected patients, adrenalectomy is part of the treatment plan.2

How it comes to light

Usually through staging or surveillance imaging for a known primary cancer. Less often, an adrenal mass is the first clue to a primary elsewhere, and workup then looks for the source.

How it is assessed

  • Imaging characterisation. CT density and washout features, MRI with chemical shift, and PET (especially FDG-PET) are used to decide whether the mass is likely metastasis versus a benign adenoma.
  • Hormone screen to exclude a functioning adrenal lesion (including phaeochromocytoma) before any biopsy or surgery.3
  • Biopsy in selected cases, and only once phaeochromocytoma has been excluded biochemically.
  • Multidisciplinary team review to weigh surgery against systemic or focal non-surgical treatment.

When surgery is considered

Adrenalectomy is a reasonable option when the adrenal deposit is isolated (or limited) metastatic disease, the primary cancer is controlled, and the patient is fit for an operation. For patients with widespread disease, systemic therapy usually takes precedence.

How the operation is done

Minimally invasive (robotic or laparoscopic) adrenalectomy is used when the tumour can be removed completely with clear margins and without capsule rupture. Larger or invasive deposits may need an open approach. See robotic adrenalectomy for general procedure detail.

The decision to operate on an adrenal metastasis depends on the primary cancer, extent of spread and overall fitness. Use contact or second opinion to arrange a review.

Considering adrenal surgery?

You can request a second opinion on imaging, hormone testing and treatment options before you decide.

Request a second opinion Call 02 8382 6980