© 2014 Wichtg Publishing U ISSN 0391-5603 Urologia ( 2015; 2): 114-117 85 CASE REPORT limited to 20 patents in the literature (6). Bilateral adrenal metastasis may be synchronous as well as metachronous as in our patent. The current study was presented here as one of the rare cases in the literature of metachronous bilateral adrenal metastasis diagnosed asymptomatcally during re- staging with 18 FDG-PET/CT. Case report Clinical and nuclear medicine features A 61-year-old man presented for routne check for operated lef renal tumor. He had undergone lef radical nephrectomy 24 months earlier. The primary pathology was clear cell carci- noma, PT2N0M0, Fuhrman grade III. Bilateral adrenal mass was found on US and CT examinaton (Fig. 1). The patent under - went 18 FDG-PET/CT due to presumed diagnosis of adrenal me- tastasis. Bilateral metachronous metastasis was found, whose SUV max was 6.7 x 50 x 38 x 20 cm on the lef adrenal gland, and another metastasis, whose SUV max was 5.5 40 x 29 x 20 on the right adrenal gland (background hepatc actvity: 3.5) (Fig. 2). Serum levels of ACTH and cortsol and urinary levels of HMA and VMA were within normal limits. The masses were considered to be hormonally inactve. It was decid- ed to perform a CT-guided biopsy. Mineralocortcoid and glucocortcoid replacement was made for possible iatrogen- ic Addison’s disease. DOI: 10.5301/uro.5000094 Bilateral metachronous adrenal metastases of operated renal cell carcinoma Hakan Ozturk 1 , Inanç Karapolat 2 , Ali Saklamaz 3 1 Department of Urology, School of Medicine, Sifa University, Izmir - Turkey 2 Department of Nuclear Medicine, School of Medicine, Sifa University, Izmir - Turkey 3 Department of Endocrinology, School of Medicine, Sifa University, Izmir - Turkey ABSTRACT Background: The adrenal glands are among the target metastatc organs due to the potental of systemic metas- tasis from renal cell carcinoma (RCC). The number of cases with bilateral metachronous metastases from RCC is about twenty. Patents and Methods: A sixty-one-year-old man presented for routne checks due to an operated lef renal tumor (clear cell carcinoma, PT2N0M0, Fuhrman grade III). The patent underwent 18 FDG-PET/CT in order to re- stage the disease upon observaton of bilateral adrenal masses on ultrasound and CT. A bilateral metachronous metastasis was found, whose SUV max was 6.7 x 50 x 38 x 20 cm on the lef adrenal gland, and another metastasis whose SUV max was 5.5 40 x 29 x 20 on the right adrenal gland. Results: The patent underwent a CT-guided biopsy and diagnosis of adrenal metastasis was made by pathological and immunohistochemical examinaton. The laparoscopic treatment was performed. Conclusions: There is no standard approach for the treatment of these patents in the literature. But metasta- sectomy is the most realistc part of the treatment. Making defnitve diagnosis with biopsy, following hormonal examinaton and treatment with minimally invasive adrenal sparing surgical procedure containing frozen-secton are strongly recommended. Cancer specifc survival signifcantly increases with metastasectomy. Keywords: Renal cell carcinoma, Adrenal metastasis, Metachronous metastasis, Diagnosis Accepted: October 2, 2014 Published online: November 22, 2014 Corresponding author: Hakan Oztürk, MD. Asst. Prof. Basmane Hospital of Sifa University Fevzipasa Boulevard No: 172/2 35240, Basmane-Konak-Izmir, Turkey drhakanozturk@yahoo.com.tr Introducton Renal cell carcinoma (RCC) accounts for 2-3% of all can- cers and its highest incidence is seen in developed countries (1). Its annual incidence all around the world is 2%. It is 1.5 tmes more common in men and the highest incidence is in the sixth and seventh decades (1). 5-year survival rate of the patents with renal cancer is 68.4 all around the world (2). Renal cell carcinoma can metastasize to almost every organ, including the lungs (50% to 60%), liver (30% to 40%), bones (30% to 40%), and brain (5%) (3). Approximately 25% of pa- tents with RCC will already have multple distant metastases at the tme of presentaton, including the lungs, lymph nodes, liver or bones (3). Ipsilateral adrenal metastasis of the RCC is seen in 1.1-10% of the cases with average of 3% but contra- lateral adrenal metastasis is quite rare with a frequency of about 0.7% (4, 5). Bilateral adrenal metastasis of the RCC is