Adrenal metastases

Abstract

The adrenal glands are one of the most prevalent sites for metastases from various malignancies and metastases are indeed the most frequent malignant tumors of the adrenals. The identification of incidental adrenal lesions, of which a high proportion are metastases, have increased since surveillance protocols in cancer treated patients were widely introduced. More sensitive and reliable methods of diagnostic imaging leads to earlier detection of adrenal metastases. If there are no signs and symptoms of disseminated malignant disease, it is essential to differentiate adrenal lesions. CT imaging diagnostics and MRI play the main role in differential diagnosis. Adrenal biopsy is not recommended and is of limited diagnostic value. Appropriate selection of patients with adrenal metastases for curative treatment is a great challenge. Hormonal evaluation should be performed prior to treatment. Adrenalectomy seems to be a reaso­nable treatment for isolated adrenal metastasis in suitable patients. Minimally invasive laparoscopic adrenalectomy is as effective as the open approach with proven reduction in postoperative pain, morbidity and length of stay. Non­surgical treatment such as stereotactic body radiation therapy (SBRT), radiotherapy with CyberKnife, percutaneous radiofrequency ablation, percutaneous microwave ablation, radiofrequency plus chemoembolization combined, have been reported with curative and palliative intent and have shown varied results.