Sandbox adrenal metastasis

Template:Adrenal metastases Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

Metastases are non calcified, vary in size and may be unilateral or bilateral.

The primary tumor is a major determinant of the frequency of adrenal metastases. Primary tumors that frequently metastasize to the adrenal include:

1. 50% of melanomas metastasize to the adrenals
2. 30-40% of breast and lung cancers
3. 10-20% of renal and gastrointestinal tumors

References

Template:Adrenal metastases Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Screening

If adrenal metastases are present on an initial imaging survey, then this indicates that stage IV disease is present. This is critical, because the presence of adrenal metastases changes the choice of treatment in most case. The only except is ipsilateral renal cancer.

Complications

One complication of adrenal metastases is central necrosis with adrenal hemorrhage.

Symptoms

Adrenal metastases are most often asymptomatic. In the event of extensive bilateral metastatic disease, signs and symptoms of adrenal insufficiency may be present which include:

• Dizziness
• Faintness
• Fatigue
• Weakness
• Weight loss

CT is first line imaging tool to screen the adrenal glands if a primary malignancy with a high for adrenal metastases (melanoma, lung cancer, and breast cancer) is present. MRI and ultrasound are of limited use in the first line screening and evaluation of adrenal metastases. Positron emission tomography (PET) may demonstrate lower metabolic activity in an incidental adrenal adenoma vs a metastasis which may be more metabolically active.