A 36-year-old female with a history of severe hypertension and acute kidney injury requiring hemodialysis was found to have an indeterminate left adrenal mass on imaging. Laboratory investigations revealed markedly elevated metanephrines, non-suppressed cortisol levels, newly diagnosed diabetes mellitus, hypothyroidismu, and significant electrolyte abnormalities. The clinical picture was suggestive of a catecholamine-induced hypertensive crisis.

During her clinical course, the patient developed multiorgan failure, including worsening renal function, metabolic derangements, and cardiovascular instability, necessitating intensive care support.

Her case was reviewed in a multidisciplinary team (MDT) meeting involving endocrinology, surgery, anesthesiology, and critical care. She was admitted to the intensive care unit (ICU) for preoperative optimization and close hemodynamic monitoring.

A left adrenalectomy was subsequently performed by a high-volume, experienced surgical and anesthetic team. The procedure was completed successfully, and the patient was transferred to the ICU postoperatively for ongoing monitoring and management.