Adrenal Ablation: Primary Tumors and Metastatic Disease

  • Michael D. Beland
  • William W. Mayo-Smith
Part of the Techniques in Interventional Radiology book series (TECHRAD)


Adrenal neoplasms are common, estimated to occur in approximately 1% of the general population. Adrenal tumors represent a diverse group of neoplasms that can be separated into primary versus metastatic disease. The most common adrenal neoplasm is a nonfunctioning adenoma, which is usually discovered incidentally on cross-sectional imaging examinations. Primary neoplasms of the adrenal gland include nonfunctioning or cortisolproducing adenomas, adrenal cortical carcinomas, pheochromocytomas, and aldosteronomas. Primary adrenal cortical carcinoma is a rare tumor originating in the adrenal cortex and up to 40–70% of patients have metastases at the time of diagnosis. Adrenal cortical carcinomas do not respond well to chemotherapy or radiation therapy and surgery has been the primary preferred method of treatment. Pheochromocytoma is a rare tumor originating in the chromaf fi n cells of the adrenal medulla. Generally, the treatment for functioning adrenal neoplasms and adrenal cortical carcinoma is surgical resection. The adrenal gland is a common site of metastases and metastasis to the adrenal gland is the most common malignant adrenal neoplasm. Lung carcinoma is the most common primary tumor that metastasizes to the adrenal gland. Other primary tumors with a propensity to metastasize to the adrenal gland include renal cell carcinoma, gastrointestinal tumors, and melanoma. Although controversial, isolated adrenal metastatic disease can be treated by surgical resection. Less-invasive techniques to treat adrenal neoplasms have been used includin percutaneous chemical ablation through the injection of alcohol or acetic acid, radiofrequency ablation (RFA), and cryoablation.

  • Adrenal tumors represent a heterogeneous group of neoplasms with widely varying prognosis and recommended medical treatments.

  • Benign nonfunctioning adenomas require no treatment.

  • The precise role of percutaneous ablation in the treatment of neoplasms has yet to be determined.

  • In general, adrenal tumors, which may be considered for surgical resection, would also be considered for image-guided ablation.

  • Image-guided minimally invasive therapy has an advantage over surgery with its attendant risks as well as increased cost and the necessity for general anesthesia.

  • To date, the largest experience has been with RFA of primary and secondary adrenal neoplasms.

  • Further prospective trials comparing RFA with traditional therapies as well as chemical ablation and cryoablation are necessary to further define its role.

  • Perhaps, the greatest potential for adrenal tumor ablation lies in the treatment of (1) recurrent disease, (2) small biochemically active tumors, and (3) isolated adrenal metastases in appropriate candidates.


Adrenal Gland Adrenal Neoplasm Adrenal Mass Adrenal Metastasis Adrenal Adenoma 
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Suggested Reading

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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Diagnostic ImagingRhode Island Hospital, The Warren Alpert Medical School of Brown UniversityProvidenceUSA

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