6375 The Dilemma Of Bilateral Adrenal Tumors: A Case Of Pheochromocytoma With Contralateral Primary Aldosteronism

Abstract Disclosure: D. Caesario: None. K.L. Hermayer: None. Introduction: Adrenal tumors (ATs), once discovered, will need to be evaluated for malignancy and autonomous hormone secretion (AHS). Up to 90% of ATs are benign, but may still have AHS, with cortisol being the most common, found in up to 30% of cases. Only 5% of ATs are pheochromocytomas (PCCs) and 2% are primary aldosteronisms (PAs). ATs of different nature may simultaneously be present in the same patient, albeit very rare. We present a case of bilateral ATs confirmed to be PCC on one side, with subsequent development of PA contralaterally. CASE REPORT: A 67-year-old male with history of hypertension (HTN) had microscopic hematuria on routine urinalysis. He was otherwise asymptomatic. HTN was controlled with amlodipine (AMLO) and carvedilol (CVDL), and physical exam was normal. CT scan revealed 3 cm right kidney mass concerning for renal cell carcinoma (RCC). It also incidentally revealed 3.6 cm right AT with unenhanced Hounsfield Unit (uHU) of 23.9 and 9 mm left AT with uHU of -6.4. Labs revealed significantly elevated plasma fractionated metanephrines (MN) and urine catecholamines, highly suspicious for PCC. BMP, dexamethasone suppression test (DST), DHEA-S, renin, and aldosterone were normal. He underwent right nephrectomy and adrenalectomy. Pathology confirmed the diagnoses of RCC and PCC. PASS score