{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T10:03:19Z","timestamp":1761645799042,"version":"build-2065373602"},"reference-count":17,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,16]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Adrenal incidentalomas are commonly discovered during imaging evaluations conducted for unrelated reasons. The majority are non-functional, benign tumours. We report a woman in her 40s who was found to have two right adrenal nodules, measuring 4.0 and 3.5\u2009cm on MRI during a fertility evaluation. Biochemical testing revealed concurrent catecholamine, cortisol and aldosterone excess. She received preoperative alpha blockade, a salt-liberal diet and fluid repletion for her pheochromocytoma, as well as spironolactone for blood pressure control of her primary aldosteronism before undergoing laparoscopic right adrenalectomy. Surgical pathology was consistent with a moderately differentiated pheochromocytoma, a cortisol-producing cortical adenoma (demonstrated by CYP11B1 immunohistochemistry) and multiple aldosterone-producing micronodules (demonstrated by CYP11B2 immunohistochemistry). Postoperatively, her catecholamine and cortisol excess resolved, while there was partial improvement in her aldosterone excess, consistent with residual primary aldosteronism. In cases of multiple concurrent adrenal pathologies, comprehensive biochemical and immunohistochemical analyses are essential for establishing a definitive diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2025-266873","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T09:55:20Z","timestamp":1761645320000},"page":"e266873","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pheochromocytoma, cortisol-producing adenoma and bilateral primary aldosteronism in a single patient"],"prefix":"10.1136","volume":"18","author":[{"given":"Jian","family":"Weng","sequence":"first","affiliation":[{"name":"Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Walser","sequence":"additional","affiliation":[{"name":"Surgery, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moosa","family":"Khalil","sequence":"additional","affiliation":[{"name":"Pathology, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Kline","sequence":"additional","affiliation":[{"name":"Endocrinology, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander A","family":"Leung","sequence":"additional","affiliation":[{"name":"Endocrinology, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3517-0910","authenticated-orcid":false,"given":"Caitlin T","family":"Yeo","sequence":"additional","affiliation":[{"name":"Surgery, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"2025102802551009000_18.10.e266873.1","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1097\/SLA.0000000000004048","article-title":"A Modern Assessment of Cancer Risk in Adrenal Incidentalomas: Analysis of 2219 Patients","volume":"275","author":"Kahramangil","year":"2022","journal-title":"Ann Surg"},{"key":"2025102802551009000_18.10.e266873.2","doi-asserted-by":"publisher","DOI":"10.1007\/BF03344099"},{"key":"2025102802551009000_18.10.e266873.3","doi-asserted-by":"crossref","first-page":"861","DOI":"10.2214\/ajr.167.4.8819372","article-title":"Adrenal radiology: distinguishing benign from malignant adrenal masses","volume":"167","author":"Dunnick","year":"1996","journal-title":"AJR Am J Roentgenol"},{"key":"2025102802551009000_18.10.e266873.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.11.1427"},{"key":"2025102802551009000_18.10.e266873.5","doi-asserted-by":"publisher","DOI":"10.1210\/jc.80.10.3009"},{"key":"2025102802551009000_18.10.e266873.6","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1210\/js.2018-00086","article-title":"Severe Cushing Syndrome Due to an ACTH-Producing Pheochromocytoma: A Case Presentation and Review of the Literature","volume":"2","author":"Gabi","year":"2018","journal-title":"J Endocr Soc"},{"key":"2025102802551009000_18.10.e266873.7","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.123.21910"},{"key":"2025102802551009000_18.10.e266873.8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S2213-8587(20)30363-6","article-title":"Maternal and fetal outcomes in phaeochromocytoma and pregnancy: a multicentre retrospective cohort study and systematic review of literature","volume":"9","author":"Bancos","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025102802551009000_18.10.e266873.9","doi-asserted-by":"crossref","DOI":"10.1530\/ERC-24-0029","article-title":"Cushing syndrome from an ACTH-producing pheochromocytoma or paraganglioma: structured review of 94 cases","volume":"31","author":"Kishlyansky","year":"2024","journal-title":"Endocr Relat Cancer"},{"key":"2025102802551009000_18.10.e266873.10","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1210\/jc.2015-2855","article-title":"Cushing Syndrome Due to ACTH-Secreting Pheochromocytoma, Aggravated by Glucocorticoid-Driven Positive-Feedback Loop","volume":"101","author":"Sakuma","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"2025102802551009000_18.10.e266873.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2009.08.002"},{"key":"2025102802551009000_18.10.e266873.12","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-012-9646-7"},{"key":"2025102802551009000_18.10.e266873.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2009.02110.x"},{"key":"2025102802551009000_18.10.e266873.14","doi-asserted-by":"crossref","unstructured":"Wurth R , Jha A , Kamilaris C , et al . A case of Carney triad complicated by renal cell carcinoma and a germline SDHA pathogenic variant. 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