Surgery is curative when a patient has a localised tumour in the adrenal gland or extra adrenal paraganglia. In the presence of metastatic disease, surgical debulking of the primary tumour to reduce catecholamine secretion intuitively seems a logical step. This talk will examine for current evidence to support or refute this concept and will discuss strategic surgical steps to minimise recurrence following adrenalectomy . There will be an emphasis on allowing the non surgeon to understand how the endocrine surgeon thinks about this disease in a multidisclipinary setting.