Objectives: The adrenal gland is one of the most common metastatic sites in lung cancer. The anatomical localization and symmetrical nature of the glands provided the concepts of laterality and resectability of adrenal gland metastasis (AGM) in lung cancer. In this trial, we aimed to investigate the clinical features and prognosis specific to ipsilateral AGM and compare them with contralateral AGM in lung cancer patients from a single tertiary center. Methods: Data of 135 lung cancer patients with AGM were retrospectively collected. The patients were divided into two groups as ipsilateral AGM and contralateral AGM. Clinicopathological features and survival outcomes were compared. Results: 57 lung cancer patients (42.2%) had ipsilateral AGM. Isolated AGM was significantly more prevalent in patients with ipsilateral AGM than those with contralateral AGM (29.4% vs. 14.1%; p=0.026). Patients with ipsilateral AGM have a survival advantage compared to contralateral AGM (The median OS: 11.6 months vs. 7.8 months; p=0.008). In multi- variate analysis, ipsilateral AGM had a favorable independent prognostic factor (Hazard Ratio=0.61; %95Confidential interval: 0.40-0.92; p=0.018). Conclusion: In patients with lung cancer, ipsilateral AGM is more likely to be isolated and is associated with a better prognosis compared to contralateral AGM.