Adrenal incidentalomas (AIs) are commonly discovered during routine medical imaging, necessitating thorough evaluation for potential hormone secretion and malignancy. This report presents a rare case of a patient with two distinct adrenal masses—a left aldosteronoma and a histopathologically confirmed right pheochromocytoma.

A 57-year-old female with hypertension and related symptoms underwent imaging revealing a 9 x 6.7 x 2.5 cm right adrenal mass and a 3.11 x 1.7 x 1 cm left adrenal lesion. Biochemical and radiological investigations identified the right mass as a pheochromocytoma. Surgical intervention involved a laparoscopic right adrenalectomy. Eleven years later, the patient presented with edemas, weight gain, muscular cramps, and fatigue. It was discovered that the left adrenal mass was transformed into an aldosteronoma.

Surgical resection of the pheochromocytoma resulted in symptom resolution and normalized catecholamine levels. Follow-up revealed no changes in the left adrenal lesion. After 11 years, primary aldosteronism manifested and was managed with antihypertensive therapy, showing clinical improvement.

This case emphasizes the importance of comprehensive preoperative assessment of hormone secretion and radiological characteristics in adrenal masses. The evolution from a non-secreting cortical adenoma to aldosteronoma indicates the dynamic nature of these lesions. The therapeutic dilemma of managing a solitary adrenal gland underscores the need for individualized treatment strategies. Continuous follow-up is crucial to monitor for changes indicative of malignancy or resistance to treatment, guiding the decision for adrenalectomy. This case highlights the significance of adhering to AI management guidelines in all patients with adrenal masses.