Surgical management of adrenal metastases

Abstract

A patient with suspected adrenal metastasis should be considered a candidate for adrenalectomy when: (a) control of extra-adrenal disease can be accomplished, (b) metastasis is isolated to the adrenal gland(s), (c) adrenal imaging is highly suggestive of metastasis or the patient has a biopsy-proven adrenal malignancy, (d) metastasis is confined to the adrenal gland as assessed by a recent imaging study, and (e) the patient's performance status warrants an aggressive approach. In properly selected patients, laparoscopic (or retroperitoneoscopic) adrenalectomy is a feasible and safe option.

Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison’s disease

“…The adrenal lesions detected in patients who were placed on follow-up after performing operation for RCC requires verification. Hormonal investigation is recommended in patients who underwent surgery due to RCC and who were found to have adrenal lesion on CT, MRI, or PET/ CT. 11 In the present case, a progressively growing adrenal metastatic lesion found in MRI and PET/CT was hormonally inactive. The mean time to metachronous metastasis was 96 months.…”

Cirugía del incidentaloma suprarrenal

“…Con respecto a la punción biópsica con aguja fina (PAAF), su principal indicación sería ante la sospecha de metástasis suprarrenal y solamente si el resultado de esta modificara la conducta terapéutica (11) . Por otra parte, tiene muy bajo rendimiento para distinguir entre un adenoma y un carcinoma suprarrenal.…”

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

“…The frequency of these masses has been determined to be approximately 5% by autopsy study and 4% by abdominal CT imaging, with increasing incidence with age. 25 The consensus by most radiologists is that small adrenal lesions with £ 10 Hounsfield units (HU) on noncontrast phases can be considered benign ''lipid-rich'' adrenal cortical adenomas and need no further imaging. Based on an NIH guidelines panel in 2002, all patients with an incidentaloma should have a functional work-up, including 1-mg dexamethasone suppression test and measurement of plasma-free metanephrines.…”

“…28 For patients with primary solid organ malignancies, the prevalence of adrenal metastasis by postmortem autopsy ranges from 10% to 27% while CT estimates range from 25% to 75%, depending on the type and size of the primary tumor. 25,29,30 Overall, given the high prevalence of adrenal adenomas in the general population, an adrenal mass discovered even in an oncology patient is most likely benign. Larger, more complex, and/or hypermetabolic masses within an adrenal gland, however, should prompt further imaging as well as functional work-up.…”