Isolated contralateral adrenal metastasis from renal carcinoma is extremely rare. Patients who present with this entity often undergo surgery with the presumed diagnosis of an incidentaloma. A mass in the contralateral adrenal diagnosed following radical nephrectomy for renal carcinoma should be viewed with a high index of suspicion for the presence of metastatic disease. Surgery is the only effective management option and should be offered to these patients.