In a single center retrospective review of 464 patients with adrenal metastases over 30 years, only five patients presented with clinical signs/symptoms of adrenal insufficiency (Addison disease). Despite the high prevalence of metastatic disease, clinical symptoms of adrenal insufficiency in these cases are rare. This is attributed to generous sinusoidal blood supply of the adrenal glands. BOWMAN, in Onco-Nephrology, 2020 Low aldosterone and low aldosterone-like statesĪdrenal metastases are the most common adrenal lesions-far outnumbering primary adrenal cancers.
Īdrenal insufficiency if large, bilateral metastases Diagnostic ChecklistĬlinical setting usually indicates correct diagnosis.Incidental adrenal lesions (“incidentaloma―) are rarely metastases Top Differential DiagnosesĬommon target organ for metastases from lung, breast, melanoma NECT attenuation 60% at 15 minutes): Likely lipid-poor adenoma □Ĭaveat: Rapid washout observed with hypervascular adrenal metastases (HCC, RCC) –įDG PET/CT: Uptake in adrenal mass significantly greater than liver suggests metastasis ○Ĭomparison to prior studies critical: New adrenal mass in patient with known (active) extraadrenal malignancy indicates metastasis ○īiopsy rarely needed for diagnosis but may be performed for equivocal lesions, particularly if surgery or ablation considered for potential isolated adrenal metastasis Imaging needed to differentiate between isolated benign adrenal lesion (typically adenoma) and metastasis during initial staging and surveillance – Increased likelihood of adrenal metastasis if history of extrarenal malignancy ○ Likelihood of adrenal metastasis at imaging depends upon clinical history ○
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