Pigmentary adrenal cortical adenoma is a special type of adrenal adenoma. The adenoma cells contain a large amount of lipofuscin or neuromelanin, which is brown-black in visual appearance. According to the reports of many cases, the incidence probability is not clear at present. Therefore, it is a topic worth exploring in terms of preferred treatment, pathological diagnosis and differentiation from other types of adrenal adenomas. Here we report a case of a nonfunctional pigmentary adrenocortical adenoma with a specific pathological pattern, the diagnosis of which depends on postoperative pathological examination and immunohistochemical examination. Surgical resection is the main treatment for this disease, most of the benign tumors have a good prognosis, and long-term postoperative follow-up should be carried out for potential malignant adrenal cortical adenomas.