Abstract: Colorectal cancer is one of the leading causes of cancer‑related mortality world-wide, with patient prognosis mainly determined by the control of metastasis. In contrast to the common metastatic sites of liver and lungs, the adrenal gland remains an uncommon metastatic organ, and there is no established consensus on the diagnosis and management of colorectal cancer with adrenal metastasis. The authors systematically review the epidemiological characteristics, potential molecular mechanisms, diagnostic methods and current treatment options of colorectal cancer with adrenal metastases.They endorse that advancements in imaging techniques have led to an increased detection rate of adrenal metastases. Although adrenal metastasis is often considered a part of systemic disease, aggressive local interventions (such as adrenalectomy) may yield survival benefits for rigorously screened patients, particularly those with isolated adrenal metastases. Multi-disciplinary team evaluations are significantly for developing personalized treatment plans, while further research into molecular drivers may pave the way for novel therapeutic approaches.