A Rare Case of Bilateral Pheochromocytomas: Diagnostic and Surgical Challenges in a 38-Year-Old Female

Pheochromocytomas are rare tumors of the adrenal medulla, and bilateral involvement is especially uncommon in the absence of a hereditary syndrome. We present the case of a 38-year-old female who presented with bilateral flank pain, excessive sweating, and palpitations. Clinical examination and laboratory investigations revealed elevated blood pressure and markedly increased serum metanephrines and normetanephrines. Imaging identified large bilateral adrenal masses with features suggestive of pheochromocytomas. A multidisciplinary team opted for a staged surgical approach: a left adrenalectomy followed by a right cortical-sparing adrenalectomy. The patient was adequately prepared preoperatively with alpha- and beta-blockers to reduce the risk of intraoperative hypertensive crisis. Histopathology confirmed pheochromocytoma in both adrenal glands. Postoperative management included steroid replacement therapy and regular monitoring of adrenal hormone levels to assess the functionality of the remaining adrenal tissue. Genetic testing was offered to assess for underlying genetic causes, but was declined by the patient. This case illustrates the importance of individualized, multidisciplinary care in managing bilateral pheochromocytomas, with emphasis on preserving adrenal function and ensuring long-term surveillance.