Isolated metastasis of renal cell carcinoma (RCC) to the contralateral adrenal gland is a rare complication occurring in 2.5% of cases. The optimal diagnosis and treatment of this condition is not well defined. We present our experience of treatment of four patients with contralateral adrenal metastasis of RCC. Six hundred twenty nine patients with RCC have been operated at our institution from 1991 to 2005. Four cases (0.6%) of isolated contralateral adrenal metastasis have been diagnosed on CT with the mean follow-up of 83.3 months (range: 23-196 months). The metastases have been detected synchronously in one and metachronously in three cases. All patients underwent adrenalectomy through flank incision above the 11th rib. Pathological stage of the tumor was pT2N0 and pT3aN0 in two patients each. Grade 2 tumor was detected in one and grade 3 in three cases. Adrenalectomy was uneventful in all patients. The mean operation time was 136 minutes (range: 110-160 minutes). No serious perioperative complications have been detected. Two patients are alive 47 and 63 months after adrenalectomy without signs of disease recurrence. Two patients died from multiple metastases 19 and 38 months after adrenalectomy, including patient with synchronous contralateral adrenal metastases. Isolated metastasis of RCC in the contralateral adrenal gland is a very rare complication. Surgical treatment is feasible and should be recommended in all cases as long-term curable effect can be observed in some cases.