The outcomes of adrenalectomy for solitary adrenal metastasis: A 17-year single-center experience

Long-term survival following adrenalectomy for secondary adrenal tumors: A systematic review and meta-analysis

BACKGROUND

Secondary adrenal tumors (SATs) are uncommon, and the benefits of adrenalectomy for SATs have not been well-established. A systematic review and meta-analysis were conducted to assess the survival benefits of adrenalectomy for SATs.

METHOD

ology: A systematic literature search was performed (1990-2022). The inclusion criteria included a known primary tumor with confirmed adrenal metastasis in patients who underwent adrenalectomy. The primary outcome was the overall survival (OS).

RESULTS

A total of 26 studies were included, with 2279 patients. The average age at the time of diagnosis was 61.1 years. Lung cancer was the most common primary tumor. The average time from primary tumor diagnosis to identification of adrenal metastasis was 17 months. The median OS was 35.2 months. One, three, and five-year OS were 79.7 ​%, 49.1 ​%, and 37.9 ​%, respectively.

CONCLUSION

The results of this review provide insight into the long-term survival of patients with SATs who underwent adrenalectomy. The study highlights the need for further research to identify the risk factors that play a role in the outcome of adrenalectomy in patients with SATs.

The clinical consequences of functional adrenal uptake in the absence of cross-sectional mass on FDG-PET/CT in oncology patients

PURPOSE

Oncology patients undergoing positron emission tomography/computed tomography (PET/CT) occasionally show discrete adrenal [18F]-fluorodeoxyglucose (FDG) uptake without an associated nodule on CT, leaving the clinician uncertain about the need to proceed with biopsy or surgical referral. This study aimed to identify the prevalence of this radiological finding and to evaluate the effectiveness of FDG uptake values in risk stratification for adrenal metastasis.

METHODS

From 2014 to 2015, oncology patients who underwent FDG-PET/CT and demonstrated elevated FDG uptake in the adrenal gland without discrete nodularity on cross-sectional imaging were included in a retrospective cohort analysis. Clinical records and FDG-PET/CT scans were reviewed for clinicopathological data, follow-up data, SUVmax (highest SUV of either adrenal gland), and SUVratio (SUVmax/background liver uptake). A receiver operating characteristic analysis was conducted to evaluate the associations between SUV values and the progression to adrenal metastasis.

RESULTS

Of 3040 oncology patients who underwent FDG-PET/CT scans, 92 (3.0%) showed elevated adrenal uptake without associated mass. From the final study cohort of 66 patients with comprehensive follow-up data, 5 patients (7.6%) developed evidence of adrenal metastasis. At SUVmax < 3.25 (AUC = 0.757) and SUVratio < 1.27 (AUC = 0.907), 34.8% and 60.6% of patients could be excluded with 100% negative predictive value, respectively.

CONCLUSIONS

Thresholds of SUVmax and SUVratio identified a significant proportion of patients who did not develop adrenal metastasis. In oncology patients who demonstrate increased adrenal FDG uptake without a discrete lesion on FDG-PET/CT, quantitative uptake values may be useful in selecting those not at risk of developing adrenal metastatic disease.

Incidental Adrenal Mass in a Patient With Surgically Treated Lung Adenocarcinoma

Adrenal metastases are not uncommon in patients with widespread metastatic lung cancer. Isolated metachronous adrenal metastases in cases of surgically treated lung cancer without long-term evidence of disease are rare and may pose a diagnostic and treatment dilemma. The current literature suggests that in such cases, adrenalectomy provides better median and overall survival rates. This case presents an incidentally discovered isolated adrenal mass in a patient with a past medical history of lung adenocarcinoma that was surgically removed three years before metastasis discovery. The patient successfully underwent adrenalectomy and was disease-free with no apparent complications at her three-month follow-up visit. The case highlights the importance of long-term radiographic surveillance after surgical resection of lung adenocarcinoma for the prompt diagnosis and timely treatment of metachronous metastases.