Metastases to the Adrenal Glands

METASTASES TO THE ADRENAL GLANDS

The adrenal glands are commonly a site for metastatic disease in patients with history of other organ cancers. Postmortem series reporting the incidence as high as 38% for patients diagnosed with extraadrenal cancers. It has been reported that about 2.5% of incidentally discovered adrenal masses are metastases from other cancers [1-8].

Clinical, surgical, and pathologic features of 164 patients were studied by B. J. Vazquez, et al [1]. They described sites of primary tumor that metastasized into the adrenal glands as following (patients number and %): Kidney 60 (37%), Lung 24 (15%), Colon 15 (9%), Pancreas 13 (8%), Neuroendocrine 7 (4%), Sarcoma 7 (4%), Leiomyosarcoma 6 (4%), Liposarcoma 6 (4%), Melanoma 6 (4%), Liver 5 (3%), Gastrointestinal tract 4 (2%), Breast 2 (1%). Lymphoma 2 (1%), Ovary 2 (1%), Thyroid 2 (1%), Cholangiocarcinoma 1 (1%), Endometrium 1 (1%), and Tonsils 1 (1%). B. J. Vazquez, et al [1] were able to follow 151 patients and found that persistent disease following adrenalectomy was present in 45 patients (30%).

Treatment

The current American Association of Clinical Endocrinologists/American Association of Endocrine Surgeons (AACE/AAES) practice guidelines for the management of incidental adrenal masses suggests that disease-free survival can be improved in a very select group of patients with good control of their extraadrenal disease and a good performance status if metastatic lesion can be resected. Resection is also helps for symptomatic palliation [6]. Study by B. J. Vazquez, et al [1] suggested that an aggressive surgical approach for adrenal metastasis results in statistically significant improvement in overall survival in selected patient cohorts with metastatic disease, especially in patients with primaries tumors arising from soft tissues (p\0.001), kidney (p\0.001), lung (p = 0.002), and pancreas (p = 0.011).

References

  1. B. J. Vazquez, M. L. Richards, C. M. Lohse, G. B. Thompson, D. R. Farley, C. S. Grant, M. Huebner, J.Moreno. Adrenalectomy Improves Outcomes of Selected Patients with Metastatic Carcinoma. World J Surg (2012) 36:1400–1405
  2. Lo C, van Heerden J, Soreide J et al (1996) Adrenalectomy for metastatic disease to the adrenal glands. Br J Surg 83:528–531
  3. Lam K, Lo C (2002) Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol (Oxf) 56:95–101
  4. Abrams H, Spiro R, Goldstein N (1950) Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer 3:74–85
  5. Brunt L, Moley J (2001) Adrenal incidentaloma. World J Surg 25:905–913
  6. Zeiger M, Thompson G, Duh Q et al (2009) The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract 1:1–20
  7. Young W (2000) Management approaches to adrenal incidentalomas: a view from Rochester, Minnesota. Endocrinol Metab Clin North Am 29:159–185
  8. Barzon L, Sonino N, Fallo F et al (2003) Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 149:273–285