Adrenal gland metastases are common and arise from multiple primary tumor types. Metastases may favor an immune privileged environment within the adrenal gland, allowing for preferential growth despite systemic therapy. With improved survival in advanced cancer, there is a growing cohort of patients living with adrenal metastases, and performance of adrenal metastasectomy is correspondingly increasing in frequency. After undergoing directed biochemical assessment to rule out a functional adrenal mass, patients may be selected for adrenal metastasectomy through a multidisciplinary discussion focusing on the biology of the malignancy, disease-free interval, synchronicity of presentation, and feasibility of resection. Patients selected for adrenal metastatectomy have longer survival compared to those undergoing non-operative management. For patients who are not surgical candidates, external beam radiation and ablative strategies can be employed for some tumor control and palliative benefits.