A 68-year-old man presented with a twelve hour history of right loin pain and frank haematuria. He had had mild symptoms of bladder outflow obstruction for one year prior to presentation. On further questioning, he admitted that he had suffered from weight loss and night sweats for the past year. His medical history included a transient ischaemic attack one year previously. On examination, he was tender in the right loin but no masses were palpable. He was slightly anaemic (Hb 12.0 g/dl) but other routine admission blood tests were normal. A mid stream urine showed >100 red blood cells/high power field.

An intravenous urogram revealed an obstruction at the right pelvi-ureteric junction, and ultrasound scanning showed two solid masses arising from the mid and upper pole of the right kidney. A computed tomogram confirmed the presence of a right sided renal mass and showed a left adrenal mass. The renal mass was biopsied and hisotlogy confirmed a renal cell carcinoma.

The right adrenal gland was left in situ. The left adrenal mass was excised. Post operative adrenal function, as measured by blood pressure, serum electrolytes and short synacthen test was normal.

Contralateral adrenal metastasis from renal cell carcinoma is described in the literature1. These may present at the time of the primary tumour2, or up to 23 years later3,4. Selli et al. report 3 cases of simultaneous bilateral metastases5. The question of sparing of the ipsilateral adrenal gland during radical nephrectomy has been raised6, concluding that the ipsilateral gland can be spared when nephrectomies are performed for mid or lower pole tumours. Obviously this becomes more important when a synchronous contralateral adrenal metastases is detected.