Surgical Management of Metastatic Disease to the Adrenal Gland

Management of Isolated Adrenal Lesions in Cancer Patients

“…Adrenal metastases can be seen in up to 40% to 50% of patients with late-stage melanomas and renal cell cancers. [6][7][8] However, with more cancers detected at earlier stages, fewer metastases are found. For example, in renal cell carcinoma, > 60% of all new cases are now incidentally detected on imaging and present with early stage I or II disease.…”

“…FNA can also help defi ne a primary malignancy of unknown origin. 6 Histologic distinction between benign adrenal lesions and primary malignant ones, however, is much less accurate, with sensitivity ranging from 54% to 86%. 17 …”

“…When they are symptomatic, they typically present with back pain representing local invasion, retroperitoneal hemorrhage from tumor necrosis, or adrenal insuffi ciency. 6 Lam and Lo 5 reported that 4% of patients with adrenal metastases presented with symptoms. Also, 1% of all patients were Addisonian due to lack of cortisol release.…”

“…24 Cytological indicators of metastatic carcinoma include increased nuclear hyperchromasia, prominent nucleoli, necrotic debris, and increased nuclear/cytoplasmic ratio in intact cells. 6 A skilled cytopathologist who can confi rm the adequacy of a specimen is critical in the accuracy of fi ne needle biopsy.…”

“…17 Patients should be questioned for signs and symptoms of a metabolically active primary adrenal tumor such as hypertension, tachycardia, headache, palpitations, hirsutism, gynecomastia, sudden weight gain, change in body habitus (particularly truncal obesity), and progressive myopathy. 6 A complete metabolic workup is necessary to identify a pheochromocytoma and any functional adrenal mass. Functional adrenal tumors effectively rule out a metastatic lesion.…”