Metastatic tumors of the adrenals

Adrenals are a common site of metastasis for many solid tumors. Adrenal metastases, and related symptoms of adrenal failure, are usually overlooked in clinical practice. This is probably due to the functional compensation of the adrenal glands and to the fact that signs and symptoms of adrenal insufficiency are aspecific, and often masked by symptoms of the neoplastic disease. In some tumors in which adrenal involvement is particularly frequent, adrenal evaluation should be an essential part of the preoperative diagnostic work-up. In case of demonstration of metastatic involvement the patient could be spared a useless resection of the primary tumor. However, in selected patients, even after the demonstration of an adrenal metastasis, radical surgery could still be considered for tumors with favorable biological behaviour. In patients with widespread disease, if clinical indicators of possible adrenal involvement are present an adequate palliative therapy should be started, thus ameliorating the quality of life of the patients.