# Metachronous Bilateral Adrenal Metastasis From Renal Cell Carcinoma Following Robot-Assisted Partial Nephrectomy: A Case Report

## TL;DR

A patient with early-stage kidney cancer developed rare bilateral adrenal metastases three years after surgery, highlighting the need for long-term monitoring.

## Contribution

This case report emphasizes the rare occurrence of bilateral adrenal metastasis from RCC and its poor prognosis.

## Key findings

- Bilateral adrenal metastasis from RCC is uncommon and indicates aggressive disease.
- The patient experienced rapid disease progression three years after initial treatment.
- Long-term surveillance is critical for early detection of late metastases in RCC patients.

## Abstract

Renal cell carcinoma (RCC) can recur or metastasize years after nephrectomy. While it is uncommon for RCC to metastasize to the adrenal glands, bilateral involvement is very rare and often indicates a more aggressive form of the disease with a poorer prognosis. Therefore, long-term surveillance following nephrectomy is crucial and may improve patients’ outcomes. Here, we present a case of a 63-year-old Caucasian male with a past medical history of hypertension, who underwent a robot-assisted right partial nephrectomy and was subsequently lost to follow-up. The pathology report revealed an unclassified renal cell carcinoma, stage 1 (PT1aN0M0). Post-operative imaging two months later showed no evidence of recurrence or metastasis. Despite initial successful management of the primary tumor, three years post-nephrectomy, the patient developed metastatic bilateral adrenal masses, distant metastasis, and rapid disease progression. We report this case to highlight the late metastatic potential of RCC, the rarity of bilateral adrenal involvement, and its associated poor prognosis, while underscoring the importance of post-surgical surveillance following resection.