Surgical Management of Metastases to the Adrenal Gland

Introduction

The most common primary malignancies associated with metastasis to the adrenal gland include breast, lung, colon, and kidney cancers, as well as malignant melanoma.1 The frequent use of abdominal imaging in patients with a known primary malignancy has led to an increase in the diagnosis of adrenal masses.2 While patients with metastatic disease often present with synchronous metastases to the adrenal gland and other organs, some patients present with an isolated adrenal mass. These patients may benefit from resection of the adrenal gland in an attempt to offer a curative therapy.

Abstract

The adrenal gland can be the site of metastatic disease in the setting of a number of primary malignancies. Differentiating a metastatic lesion from a primary adrenal lesion is important and may require the use of radiologic imaging, an endocrinologic evaluation, and adrenal biopsy. Adrenal biopsy may be especially useful in those patients with a known primary malignancy in order to determine whether the patient is a candidate for metastatectomy or systemic therapy. Patients with isolated adrenal metastases may have superior outcomes from adrenalectomy as compared to chemotherapy. In the past, open adrenalectomy was the standard of care for patients with an isolated adrenal metastasis, but recently laparoscopic adrenalectomy has been utilized with favorable outcomes. Appropriate patient selection for the surgical approach is critical to determine the best treatment for the individual patient.

Keywords

adrenal gland, adrenalectomy, metastasis, laparoscopic, cryotherapy, radiofrequency ablation