Unilateral mixed corticomedullary tumor of the adrenal gland with a synchronous contralateral pheochromocytoma: A case report and literature review

Abstract

A 37-year-old man had two years of fatigue, weakness, and mood changes, initially misdiagnosed as depression. Workup showed hypertension, elevated urinary normetanephrine, elevated free cortisol, and suppressed ACTH. Imaging revealed bilateral adrenal masses (7.5 cm left, 4.7 cm right) with left adrenal vein thrombosis; MIBG scintigraphy showed bilateral uptake. After alpha-blockade, he underwent bilateral adrenalectomy. Inhibin positivity in the left mass's cortical region suggested a possible first-reported unilateral mixed corticomedullary tumor with synchronous contralateral pheochromocytoma, though entrapped cortical cells couldn't be excluded without further markers. Elevated Ki-67 and bilateral involvement warrant long-term follow-up and genetic evaluation.