Adrenal metastases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

The pathogenesis of adrenal metastases is characterized by metastases from renal cell carcinoma, melanoma, lung cancer, colorectal cancer, breast cancer and lymphoma. On gross pathology, unilateral, small asymptomatic lesion are characteristic findings of adrenal metastases. Adrenal metastases must be differentiated from other diseases that cause tumors in adrenal gland such as nonfunctional adenoma, primary carcinoma in adrenal glands, adrenal cyst, and non-functional pheochromocytoma. Adrenal metastases are thought to be present in up to 27% of patients with known malignant epithelial tumors at autopsy. Symptoms of adrenal metastases may include dizziness, faintness, fatigue, weakness, and weight loss. CT is the imaging modality of choice for adrenal metastases. The mainstay of therapy for adrenal metastases is chemotherapy.

Pathophysiology

• Adrenal metastases occur secondary to hematogenous seeding of neoplastic cells from renal cell carcinoma, melanoma, lung cancer, colorectal cancer, breast cancer and lymphoma.
• On gross pathology, a unilateral, small asymptomatic lesion is a characteristic finding of an adrenal metastasis.

Differentiating Adrenal metastases from other Diseases

• Adrenal metastases must be differentiated from other diseases that cause tumors in adrenal gland such as:

• Nonfunctional adenoma
• Primary carcinoma in adrenal glands
• Adrenal cyst
• Non-functional pheochromocytoma

Epidemiology and Demographics

• Adrenal metastases are thought to be present in up to 27% of patients with known malignant epithelial tumors at autopsy.

Natural History, Complications and Prognosis

• If left untreated, 20-35% of patients with cancer may progress to develop adrenal metastases.
• Complications of adrenal metastases include central necrosis with adrenal hemorrhage and paraneoplastic leukemoid reaction.

Diagnosis

Symptoms

• Symptoms of adrenal metastases may include the following:

• Dizziness
• Faintness
• Fatigue
• Weakness
• Weight loss

Physical Examination

• Patients with adrenal metastases usually appear cachectic.
• Physical examination may be remarkable for:

• Abdominal mass

Laboratory Findings

• There are no specific laboratory findings associated with adrenal metastases.

Imaging Findings

• CT is the imaging modality of choice for adrenal metastases.
• On CT, adrenal metastases may demonstrate less than 50% washout.
• On MRI, adrenal metastases may demonstrate:

• T1: usually exhibit low signal intensity
• T2: usually exhibit high signal intensity
• T1 C+ (Gd): usually has progressive enhancement after administration of contrast material.

Treatment

Medical Therapy

• The mainstay of therapy for adrenal metastases is chemotherapy.

Surgery

• Adrenalectomy in conjunction with chemotherapy is the most common approach to the treatment of adrenal metastases if primary disease is well controlled and the only site of metastasis if adrenal gland.

Prevention

• There are no primary preventive measures available for adrenal metastases.