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Metastatic lesions to the adrenal gland are usually silent, although their incidence is especially high in patients with carcinomas of the breast and lung, and melanoma. After reviewing the sonograms of over 50 patients with adrenal masses, 10 were found to have bilateral metastases. This has prompted us to describe the "head light" sign as an accurate method for diagnosing bilateral adrenal metastases.

Nine cases of suprarenal masses without endocrine abnormalities are presented: 2 adrenal pseudocysts, 2 adrenal myelolipomas, 2 neuroblastomas, 1 lymphoma metastatic to the adrenal glands, 1 teratoma, and 1 adrenal cortical carcinoma metastatic to the contralateral gland. The clinical and radiologic findings are discussed. Noninvasive and invasive procedures and their usefulness in diagnosing masses in the suprarenal area are reported. The importance of metastases to the adrenal glands in the differential diagnosis of suprarenal masses was investigated by reviewing the autopsies done from January through June, 1979, at The University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute, Houston, Texas. Adrenal metastases were found in 26 per cent of the cases studied. Breast and lung carcinomas and lymphomas were the most commonly found neoplasia. The relative incidence of microscopic and macroscopic metastases in all patients with tumor is discussed.