Adrenal metastases.

The adrenal gland is a frequent location for metastatic spread of a various number of malignant tumors. Among all tumors, carcinoma of lung, breast, ovary and malignant melanoma count to the most frequent ones. In nononcological and unselected populations, the prevalence of adrenal metastases is 0-21 %. The metastases are mostly discovered in patients during their follow-up carried out in consequence of their antecedent malignant disease. A malignant disease in adrenal gland may occasionally manifest as a solitary metastasis referred to as adrenal incidentaloma. If the malignant disease is disseminated at the time of adrenal mass diagnosis, no further differentiation of lesion is necessary as it does not influence the further therapeutic process. If the dissemination is not present, further differentiation of adrenal lesion is essential. CT and MRI characteristics of the adrenal mass play the key role in the differential diagnosis. The examination of adrenal overproduction is not necessary in case of known adrenal metastasis except when performing tests in order to rule out the catecholamine overproduction. In case of bilateral metastases, adrenal insufficiency should be also excluded. Surgical treatment is indicated in cases of solitary metastasis. The further management of patients with adrenal metastases belongs to the oncologist. The prognosis of the disease is usually very poor with average survival rate of three months (Fig. 2, Ref. 34).