What Is Adrenal Gland Metastasis? Which Cancers Commonly Cause It?

Adrenal metastasis refers to cancer that spreads from elsewhere in the body to the adrenal glands . In many cases, adrenal tumors  may be benign, but cancer can also spread to adrenal tumors from other areas of the body, such as the lungs or kidneys.

The glands above the kidneys, known medically as adrenal glands, are common sites of metastasis from various cancers.

The adrenal glands  are two small glands, one above each kidney. They produce hormones that help control important functions such as heart rate and blood pressure, including  adrenaline  and  norepinephrine .

What Is Adrenal Metastasis?

Adrenal metastasis  refers to cancer originating elsewhere in the body that spreads to the adrenal glands. The adrenal glands are among the most common sites to which cancer spreads. 

Adrenal metastasis may be unilateral, affecting one adrenal gland, or bilateral, affecting both glands.

What Are the Symptoms?

Adrenal metastasis usually causes no symptoms. Possible general symptoms may, however, include pain around the tumor, such as back or abdominal pain. 

If metastases occur in both adrenal glands and affect more than 90% of the glands, a person may develop adrenal insufficiency . Symptoms of adrenal insufficiency include:

• Significant weight loss
• Nausea
• Fatigue and weakness
• Abdominal pain
• Lethargy (a deep and persistent state of sleepiness)
• Fever
• Clouded consciousness or confusion
• Electrolyte imbalances

A person may also experience general symptoms of metastatic, or stage 4, cancer:

• Extreme fatigue or weakness that makes daily activities difficult
• Pain
• Shortness of breath or difficulty breathing
• Unintentional weight loss

Causes and Risk Factors

Cancer elsewhere in the body can spread to the adrenal glands, causing adrenal metastasis.

Cancers that most commonly spread to the adrenal glands include:

• Lung cancer
• Breast cancer
• Gastrointestinal (stomach and intestinal) cancers
• Pancreatic cancer
• Kidney cancer

Some cancers may carry a higher risk of adrenal metastasis. A 2020 study involving 579 people with adrenal metastases showed that  lung, genitourinary, and gastrointestinal cancers were the cancers most commonly  spreading to the adrenal glands.

Diagnosis and Treatment

Standard cancer diagnostic tests can detect adrenal metastasis. Approximately 30% to 70% of adrenal metastases are found incidentally, on abdominal imaging performed for another purpose.

Adrenal metastases may be detected using the following tests:

• Imaging scans to help determine whether a tumor is benign or cancerous, such as MRI, CT, or PET-CT .
• Fine-needle biopsy to collect a sample from the adrenal glands for laboratory testing for cancer cells
• Blood tests measuring cortisol and adrenocorticotropic hormone (ACTH), which can indicate how well the adrenal glands are functioning

Treating the cancer that caused the adrenal metastasis is the most effective way to treat adrenal metastasis. Treatments may include chemotherapy, radiotherapy, or immunotherapy.

If adrenal metastasis is suitable for surgical removal,  adrenalectomy  may be performed. For adrenal tumors smaller than 6 centimeters, laparoscopic surgery is generally preferred because it is minimally invasive and may cause fewer problems than open surgery. Small incisions are made in the abdomen or back, and instruments introduced through a laparoscope (a thin tube) are used to remove the adrenal gland. 

Larger tumors may require open surgery to remove the cancerous tissue in one piece, preventing the tumor from breaking apart and the cancer from spreading.

Other possible treatments for adrenal metastasis include radiation, heat, or cryoablation (freezing) to destroy a tumor.

The Outlook for Adrenal Metastasis

According to a 2022 study, surgery to remove adrenal metastases is a safe treatment option and may provide long-term survival. Open surgery required for a large tumor or metastases beyond the adrenal glands may have less favorable effects.

For people undergoing adrenalectomy, factors associated with a favorable outlook include the cancer not having spread to structures surrounding the adrenal glands. Another factor is having no signs of disease for more than six months after the primary cancer was first diagnosed.

The overall outlook for adrenal metastasis may depend on the primary cancer type and response to treatment.

A 2020 study identified the following factors associated with an increased risk of death:

• Older age
• Adrenal metastasis originating from the lungs
• Metastases affecting both adrenal glands rather than only one
• Not having surgery to remove the cancerous adrenal gland

When Should You See a Doctor?

Adrenal metastasis may cause no symptoms. However, anyone with cancer or a history of cancer who develops back or abdominal pain should consult a specialist. Remember that these symptoms may also have other causes. People with symptoms of adrenal insufficiency should also consult a specialist promptly:

• Fatigue
• Nausea
• Weight loss
• Fever
• Clouded consciousness or confusion

People should also consult a specialist if they develop general symptoms that could suggest their primary cancer has spread, including:

• Extreme fatigue or exhaustion
• Unexplained weight loss
• Pain
• Difficulty breathing or shortness of breath

Frequently Asked Questions

1. What Is the Survival Rate for Metastatic Adrenal Cancer?

The 2022 results of a study examining 435 people who underwent surgery to remove adrenal metastases between 2000-2018 showed that approximately a third survived for 5 years after the operation. 

Other factors, including tumor size, primary cancer type, spread to other areas, age, and overall health, may also affect survival rates.

2. Can Adrenal Metastasis Be Treated?

According to the 2022 study, adrenal metastasis can be treated if the entire adrenal tumor can be removed with clear margins. This also means removing cancer cells in the surrounding tissues. Surgical removal or successful treatment of the primary tumor is another factor.

3. How Long Do Patients With Adrenal Cancer Live?

Specialists assess this using the 5-year relative survival rate for the cancer concerned: the percentage of people alive 5 years after diagnosis. According to the American Cancer Society, the 5-year relative survival rates for people diagnosed with adrenal cancer are as follows:

• Localized  (Cancer has not spread from its original site to surrounding tissues)  73%
• Regional  (Cancer has spread from its original site to nearby lymph nodes or other nearby organs)  53%
• Distant  (Cancer has spread from its original site to distant organs or tissues)  38%
• All stages  (All cancer stages combined)  50%

Adrenal Metastasis: Summary

Adrenal metastasis means that cancer has spread to the adrenal glands from another part of the body. Cancers beginning in the lungs, breast, gastrointestinal tract, or kidneys may spread to the adrenal glands and other parts of the body. Treatment may include radiotherapy, chemotherapy, surgical removal of the primary cancer, direct surgical removal of the adrenal metastasis, or other cancer treatments.

Successful treatment of the primary cancer and complete removal of the adrenal tumor may potentially cure adrenal metastasis.