Metastasis to the adrenal glands: An update

Table 4 Summary of guideline recommendations and practical implications

Guideline/source	Scope/context	Directness to adrenal metastases	Relevant message
AAES adrenalectomy guideline (2022)[54]	General adrenal surgery	Direct	Multidisciplinary team selection; biopsy rarely; resection may be offered to highly selected patients
ESE/ENSAT adrenal incidentaloma guideline (2023)[55]	Adrenal mass evaluation in patients with extra-adrenal malignancy	Direct for work-up	Metanephrines; positron emission tomography/computerised tomography/surgery/biopsy if management changes; consider surgery if only metastasis
EAU RCC guideline (2024/2025)[56]	Metastatic renal cell carcinoma	Direct for renal cell carcinoma	Consider metastasectomy/ablative therapy in favourable disease if complete resection is feasible
ESMO RCC guideline (2024)[57]	Metastatic renal cell carcinoma	Direct for renal cell carcinoma	Metastasectomy not routine within 1 year of nephrectomy; local therapy in selected cases
SAGES adrenal pathology guideline (2013)[51]	Operative approach to adrenalectomy	Indirect	Minimally invasive adrenalectomy preferred for suitable non-primary adrenal cancer pathology
NCCN Guidelines for Patients: Kidney Cancer (2025)[58]	Patient-facing kidney cancer guidance	Indirect; renal cell carcinoma specific	Oligometastatic options include metastasectomy, radiation, or ablation

AAES: American Association of Endocrine Surgeons; ESE/ENSAT: European Society of Endocrinology/European Network for the Study of Adrenal Tumors; ESMO: European Society for Medical Oncology; EAU: European Association of Urology; SAGES: Society of American Gastrointestinal and Endoscopic Surgeons; NCCN: National Comprehensive Cancer Network.