Metastasis of gastric adenocarcinoma to the adrenal gland is rare. In the literature, adrenal gland metastasis has been reported generally during postoperative follow-up. We aimed to discuss a gastric cancer case with left adrenal gland metastasis diagnosed preoperatively and the simultaneous surgical resection of the gland during total gastrectomy with D2 dissection. A preoperative abdominal computed tomography (CT) scan revealed thickening of the adrenal gland in a 65-year-old male patient diagnosed with gastric adenocarcinoma located at the cardia. A positron emission tomography/computed tomography (PET-CT) scan was performed and showed an isolated adrenal metastasis. Total gastrectomy with D2 lymph node dissection and simultaneous left adrenalectomy were performed. The histopathological examination revealed gastric tumor tumor extending to the serosa (T4), 15 out of 43 lymph nodes positive (N3), adrenal gland metastasis (M1); thus stage 4 disease. There has been no metastasis in the 15month follow-up period. Although management of metastasis in gastric carcinoma is controversial, we suggest the evaluation of the resection potential of isolated metastases in gastric cancer as performed in many other types of cancer.