Occurrence and significance

Metastases to the adrenal glands are a fairly common finding in oncological patients. Their presence — often bilateral — can fundamentally affect the further diagnostic and therapeutic procedure.
For patients who have already been diagnosed primary tumor, adrenal involvement occurs only in 20% of cases.
Conversely, in patients without a known primary tumor, the incidence of metastases to the adrenal glands is rare (less than 0.5%).

The most common sources of metastasis

Non-small cell lung carcinomas
Breast cancer and kidney cancer
Malignant melanoma — with a marked tendency to disseminate, including adrenal glands
Colorectal cancer — less common, but possible with advanced disease
Other less common sources:
- carcinomas of the stomach, pancreas, esophagus, prostate, ovaries, endometrium
- urothelial carcinoma
- sarcomas
- neuroendocrine tumors
- choriocarcinoma

Metastases to the adrenal glands, as a rule, appear in advanced tumor diseases.

Typical symptoms

Most patients are asymptomatic — the finding is often debunked randomly during CT or MRI. Clinical manifestations occur primarily in bilateral disability with development adrenal insufficiency.

Typical manifestations of adrenal insufficiency:

chronic fatigue and weakness
low blood pressure
lack of appetite, weight loss
nausea, vomiting, abdominal pain
hyperpigmentation of the skin, increased temperature

In acute cases, it can arise Adrenal crisis, a life-threatening condition with severe hypotension, impaired consciousness and risk of collapse.
Therefore, in patients with bilateral foci in the adrenal glands, it is crucial to have this option think actively and respond in a timely manner.

Diagnostics

Clinical evaluation

Careful evaluation of the general condition of the oncological patient, focusing on possible symptoms of adrenal insufficiency.

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Not sure how best to proceed?

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Anatomical imaging methods

CT
- A value > 30 HU (before contrast) is highly suspicious for metastasis
MR
- Hyperintense signal on the T1 sequence (“bright”) is common in metastases
Bilateral disability is common in cancer patients and increases the suspicion of metastasis

Functional imaging

FDG PET/CT
- Almost all metastatic lesions are PET-positive

Biopsy

Biopsy is indicated only in caseswhen:

by verifying metastasis fundamentally influenced further treatment
was upfront excluded pheochromocytoma

Treatment options

The chosen approach depends on:

The extent of the disease
presence of other metastases
type of primary tumor
general condition of the patient

1. Surgical treatment

Considered in isolated adrenal involvement, without other metastases, especially if the primary tumor has already been removed.
The goal may be a curative effect or prolonging survival.

2. Ablative methods

Radiofrequency ablation (RFA)
Cryoablation

Used when surgery is not possible. They require an experienced multidisciplinary team.

3. Systemic oncology treatment

Mostly the main therapeutic option:

chemotherapy
immunotherapy
radiotherapy
targeted treatment

4. Hormone substitution

With the development of adrenal insufficiency:

cortisol (hydrocortisone)
fludrocortisone

Therapy should be started immediately, ideally already at Strong clinical suspicionThis is even before the diagnosis is finally confirmed.

Recommendations

In oncological patients with foci (or multiple foci) in the adrenal glands always consider the possibility of metastasis
Caution is also required in patients with:
- Low blood pressure
- fatigue
- by lack of appetite
- nausea and vomiting
Both treatment and diagnosis should take place within a multidisciplinary team involving oncologists, endocrinologists, radiologists, surgeons and other specialists

Metastases to the adrenal glands