Yu JR, Tan THM, Rao AD, Balasubramaniam S, Shelat VG. Metastasis to the adrenal glands: An update. World J Clin Oncol 2026; 17(7): 122037 [DOI: 10.5306/wjco.122037]
Corresponding Author of This Article
Vishal G Shelat, FRCS, Adjunct Associate Professor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
review-article
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World J Clin Oncol. Jul 24, 2026; 17(7): 122037 Published online Jul 24, 2026. doi: 10.5306/wjco.122037
Metastasis to the adrenal glands: An update
Jing-Rong Yu, Tee Hui Maxim Tan, Anil D Rao, Sunder Balasubramaniam, Vishal G Shelat
Jing-Rong Yu, Tee Hui Maxim Tan, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Anil D Rao, Department of General Surgery, Khoo Teck Puat Hospital, Singapore 762228, Singapore
Sunder Balasubramaniam, Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Co-first authors: Jing-Rong Yu and Tee Hui Maxim Tan.
Author contributions: Yu JR and Tan MT contributed equally to this work, revised the figures, formatted the tables and made critical revisions to the manuscript, thus qualified as the co-first authors of the paper; Rao AD and Balasubramaniam S contributed to conceptualization of the study, editing of the original draft and supervised the review; Shelat VG performed the literature retrieval, contributed to conceptualization, writing and editing of the original draft and supervised the revisions; all the authors prepared the draft and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Vishal G Shelat, FRCS, Adjunct Associate Professor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@gmail.com
Received: April 16, 2026 Revised: July 5, 2026 Accepted: July 8, 2026 Published online: July 24, 2026 Processing time: 107 Days and 22.5 Hours
Abstract
Adrenal metastases are increasingly detected during cancer staging and post-treatment surveillance, yet diagnostic and therapeutic pathways remain heterogeneous. Distinguishing benign adrenal lesions from metastases is clinically important when the lesion is solitary, potentially oligometastatic, or may alter systemic treatment strategy. This narrative review summarizes evidence on epidemiology, diagnostic evaluation, and treatment for adrenal metastases, with emphasis on decision-making in oligometastatic and oligoprogressive disease. The review was developed using Scale for the Assessment of Narrative Review Articles principles, with focused literature retrieval from biomedical databases, guideline sources, landmark series, systematic reviews, comparative studies, and reports on imaging, biopsy, adrenalectomy, percutaneous ablation, and stereotactic body radiotherapy. Cross-sectional imaging remains central, but indeterminate lesions often require multiparametric assessment using adrenal-protocol computed tomography (CT), magnetic resonance imaging, and selected positron emission tomography/CT. Biopsy should be reserved for cases in which imaging remains equivocal and histology will change management. For carefully selected patients with isolated or limited adrenal metastasis, adrenalectomy may provide durable local control and survival. Percutaneous ablation and stereotactic body radiotherapy offer lower-morbidity alternatives for non-operative candidates or anatomically challenging lesions. Management should follow an intent-based framework integrating diagnostic confidence, tumor biology, systemic treatment response, lesion anatomy, patient fitness, and goals of care.
Core Tip: Adrenal metastasis is increasingly identified during staging and surveillance, but outcomes vary widely by primary tumor biology, rate of progression, and whether disease is truly isolated. Management should follow an intent-based pathway: Confirm diagnosis with high-quality imaging, reserve biopsy for indeterminate lesions when results will change treatment and select local therapy accordingly. For carefully chosen patients, adrenalectomy offers durable control; percutaneous ablation and stereotactic body radiotherapy provide effective, lower-morbidity alternatives for non-operative candidates or anatomically challenging lesions. Standardized selection criteria and stratified reporting are essential to define when local treatment meaningfully changes trajectory.
