Adrenal incidentaloma is an incidentally discovered adrenal mass>1cm found in the course of abdominal imaging performed for reasons other than suspected adrenal pathology. While majority of them are benign, non-functioning lesions, a significant proportion of them comprises functioning and/or malignant lesions. Here we present a series of 5 rarest of rare cases of adrenal disorder, that created a dilemma in either presentation, diagnosis or treatment per se.

Institution based observational study, case series of 5 patients in a tertiary care centre of Kolkata.

Case1:- The great mimicker A hexagenerian lady with unilateral hyperfunctioning left adrenal mass with retroperitoneal lymphadenopathy, elevated DHEA-S, suspected of adrenocortical carcinoma. HPE following left adrenalectomy with RPLND revealed adrenal tuberculosis, started on ATD, leading a normal life. Case2:- Dilemma of laterality A 35 years old lady with clinical features and imaging s/o unilateral Conn's adenoma, selective adrenal venous sampling suspected bilateral disease. Bilateral lap adrenalectomy was done, HPE confirmed bilateral adenoma. Case3:- Giant !! A 60 years old lady with 18x15 cm right giant pheochromocytoma, weighing 820g, presenting with atypical features. Case4 :- Faint hearted 22 years male with bilateral pheochromocytoma with dilated cardiomyopathy ( LVEF- 18%), with VHL leading a healthy life following bilateral adrenalectomy. Case5 :- Little princess with "biological time bomb" 7 years old girl with classical triad of pheochromocytoma, diagnosis aided by MRI and biochemical tests, underwent right lap adrenalectomy, thereafter leading a normal life.

Adrenal tumors are rare, may present with atypical features. Early diagnosis and appropriate management may gift the patient a normal life.