Four cases of nonfunctioning adrenal adenomas associated with renal cell carcinoma are reported. The adenomas were found incidentally during angiographic examination of the renal carcinoma, and originally were thought to be metastases to the adrenal gland. Reports in the pathologic literature indicate an increased incidence of adrenal adenomas in patients with renal cell carcinoma. Adrenal adenomas occur in 12%-15% of patients with renal cell carcinoma as compared to 2%-3% of the general population. Since a vascular metastasis to the adrenal gland and an adrenal adenoma may appear identical angiographically, awareness of this association is important to avoid overdiagnosis of metastatic disease.