Solitary adrenal gland metastasis detected at 24-month follow-up for muscle-invasive bladder cancer

Solitary adrenal metastasis from bladder urothelial carcinoma is extremely uncommon. We report a 52-year-old man with high-grade pT3bN0R0 urothelial carcinoma of the bladder, who developed a solitary right adrenal metastasis (59 × 31 mm) 20 months after neoadjuvant chemotherapy and cystectomy (visible at the November 2024 CT, absent in March 2024). Surgical adrenalectomy was aborted due to adhesions and muscular invasion. After systemic therapy, the disease progressed with bilateral adrenal involvement. Adrenal metastases occur in 14% of bladder cancer cases, isolated adrenal involvement is rare and aggressive; guidelines emphasise individualized multimodal management and suggest that earlier PET/CT may improve outcomes.