Cushing's Syndrome Due to Primary Bilateral Macronodular Adrenal Hyperplasia and Metachronous Pheochromocytoma

This case study reports on a 43-year-old woman with recurrent Cushing's syndrome (CS) due to primary bilateral macronodular adrenal hyperplasia (PBMAH) and a newly developed pheochromocytoma (PCC). Initially, she underwent a right adrenalectomy, which led to weight loss and improved well-being. However, two years later, she experienced a recurrence of CS with paroxysmal hypertension, leading to the removal of the left adrenal gland. Histopathology confirmed PCC and macronodular–micronodular hyperplasia. This case highlights the rarity of synchronous PCC and ACTH-independent CS from the same adrenal gland and emphasizes the need for thorough re-evaluation in recurrent cases to prevent severe complications.