Adrenal metastases: Specialists & information

Adrenal metastases are metastases that originate from malignant tumors in other parts of the body. Cancer cells from a lung carcinoma often spread to the adrenal gland, but other types of cancer can also spread to the adrenal gland. Due to the location and good blood supply of the adrenal glands, they are one of the organs most frequently affected by metastasis.

Here you will find further information as well as selected specialists and centers for adrenal metastases.

Background information

The adrenal gland is an organ about 3 x 1.5 cm in size that sits on top of the kidney. As humans have two kidneys, there are also two adrenal glands, one on each kidney. From a structural point of view, the adrenal gland consists of

• an outer part, the adrenal cortex, and
• an inner part, the adrenal medulla.

Both areas produce vital hormones for the body, including

• Cortisol: Influences the metabolism and immune system and is considered an important stress hormone.
• Aldosterone: Regulates the salt and water balance.
• Adrenaline,
• noradrenaline and
• dopamine.

The adrenal gland sits on top of the kidney, as can be seen above right. Metastases often form in the adrenal gland © Henrie | AdobeStock

Forms of adrenal tumors

Various tumors or masses can form in the adrenal glands:

Metastases are metastases from primary tumors elsewhere in the body. The cancer cells reach the adrenal gland via the bloodstream or the lymphatic system and form metastases there. Lung cancer is often the primary tumor. Adrenal metastases are among the most common tumors: about half of adrenal tumors are metastases.

However, adrenal metastases are not the same as adrenal cancer (adrenal carcinoma). In contrast to metastases, adrenal cancer forms directly in the adrenal glands.

Other tumors of the adrenal glands are

• benign tumors (adrenal adenoma) and
• Pheochromocytomas (mostly benign tumors of the adrenal medulla).

Symptoms

The adrenal glands produce important hormones. The growth of a metastasis in the adrenal gland can cause changes in the metabolism.

For example, a metastasis in the adrenal cortex displaces the cortisol-producing tissue. As a result, it produces too little cortisol. This very often leads to adrenal insufficiency, which is known as Addison's syndrome or Addison's disease.

Symptoms of Addison's disease include

• Fatigue,
• weakness and
• dizziness.

Causes and risk factors

An adrenal metastasis is always due to cancer in another organ. For example, the primary tumors are located in the following organs:

• Lung (especially in small cell bronchial carcinoma/lung carcinoma)
• Breast (for breast cancer)
• Kidney (for kidney cancer or renal cell carcinoma)
• Stomach (for stomach cancer)
• Pancreas (also known as pancreas; for pancreatic cancer or pancreatic cancer)
• Ovary (also known as ovary; for ovarian cancer or ovarian carcinoma)
• Large intestine (also known as the colon; for colon cancer, this usually refers to colon cancer or colon carcinoma)

Whether a cancer metastasizes to the adrenal glands depends, among other things, on

• the malignancy of the primary tumor,
• the time at which the cancer was diagnosed, and
• the success of the cancer therapy

depends.

The later a cancer is discovered, the higher the risk that the tumor has already metastasized to other organs such as the adrenal gland. For example, by the time a bronchial carcinoma, kidney cancer or melanoma is diagnosed, around 15 percent of all patients already have adrenal metastases.

Examination and diagnosis

Adrenal metastases are usually

• as part of spread diagnostics, i.e. when specifically searching for metastases after a cancer diagnosis, or
• during follow-up examinations of tumor patients who have already been treated.

tumor patients who have already been treated. In some cases, adrenal metastases are incidental findings during a computer tomography (CT) scan or an ultrasound examination. If tumors are discovered by chance, they are referred to as incidentalomas.

Adrenal metastases can be recognized very well on CT. If a conspicuous structure is discovered in an adrenal gland during a CT scan or an ultrasound scan, the doctor must first check whether it is a metastasis. For this purpose, the adrenal gland is examined again using higher-resolution imaging techniques. This includes

• a contrast medium CT scan,
• magnetic resonance imaging(MRI) or
• a combination of positron emission tomography (PET) and CT (known as PET-CT).

can be considered.

In addition, cortisol and other laboratory parameters are usually determined in the blood and/or urine. These so-called hormone diagnostics allow other diseases (such as Cushing's syndrome or a pheochromocytoma) to be ruled out.

If an adrenal metastasis is suspected due to

• a detected primary tumor,
• CT imaging of the tumor and
• a pheochromocytoma that has been ruled out by hormone diagnostics

is confirmed, a tissue sample should be taken. A fine needle is inserted through the skin into the adrenal gland under computer tomography control. During this so-called fine needle biopsy, some tissue material is removed. A pathologist then examines the tissue sample histologically under a microscope.

The tissue sample can be used to determine beyond doubt whether a metastasis or another tumor is present.

General information on treatment

The treatment of adrenal metastases is adapted to the patient's individual situation. It depends, for example, on whether the primary tumor has already been removed or can be removed at all. Possible therapeutic options are

• Surgical removal of the metastasis together with the adrenal gland(adrenalectomy)
• chemotherapy
• Local destruction of the tumor using heat generated by radiofrequency current ( radiofrequency ablation)
• Radiotherapy

If possible, surgical removal of the metastasis is attempted: Smaller metastases can be removed as part of a laparoscopy. Larger metastases are removed by open abdominal surgery.

If the adrenal gland has to be removed, the body may still be able to produce hormones via the second adrenal gland. If this is not possible, the patient may have to take cortisol temporarily or permanently.

Progression and prognosis

The prognosis depends largely on

• which cancer the adrenal metastasis is based on,
• how far this cancer has already progressed and
• whether it has been successfully treated.

However, metastasis always means that the cancer has spread. The primary tumor is therefore already at an advanced stage.

It isfavorable for the prognosis and thus for life expectancy if

• there are more than two years between the diagnosis of the primary tumor and the appearance of the adrenal metastasis,
• there are no other metastases in other organs and
• the cancer has been completely removed.

Prevention

Kidney metastases cannot be prevented. It is therefore crucial that the underlying cancer is detected early and the risk of metastasis is minimized.

You should therefore attend the recommended cancer screening examinations regularly. If you have already been treated for cancer, make sure you attend your check-up appointments regularly. This is the only way to detect metastases at an early stage.