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A right homogeneous adrenal tumor was found incidentally, during abdominal computed tomography in a 72-year-old female patient, presenting with hypertension of 2 years duration. She had an elevated Aldosterone: Renin Ratio (ARR) and primary hyperaldosteronism was confirmed with a fludrocortisone suppression test. Plasma basal cortisol and adrenocorticotropic hormone (ACTH) levels were normal, but the plasma cortisol concentration could not be suppressed with dexamethasone. Therefore, an adrenal cortical adenoma with primary hyperaldosteronism and subclinical hypercortisolism was suspected. Urinary total metanephrines and vanillylmandelic acid (VMA) levels were also marginally elevated, indicating the possibility of a pheochromocytoma. After right adrenalectomy, the tumour was histologically demonstrated to be a pheochromocytoma, and the levels of all three hormone groups viz corticosteroid, mineralocorticoid and metanephrine levels normalized, indicating the possibility of a cosecretory small adrenocortical microadenoma.

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