Sir, The widespread use of imaging procedures has led to an increased discovery of incidental masses in the adrenal glands. The probability of finding an adrenal adenoma on abdominal computed tomography (CT) increases with age and is ∼0.2 % in 20–29 years age group as compared to 7% in the elderly people.1,2 Although the majority of these incidentaloma’s are non-functioning benign adenoma’s but their increased prevalence poses a diagnostic and therapeutic challenge. The natural history of adrenal incidentaloma’s is yet to be clearly defined as they may present at a later date as cortisol secreting adenomas, pheochromocytoma, adrenal cortical carcinoma and metastatic carcinoma. This possibility of conversion from a non-secreting state to an autonomous hypersecretory tumor is low but careful assessment and vigilance is needed with timely follow-up for early diagnosis. We present one such patient who had a benign adenoma at presentation but went on to develop an adrenal cortical carcinoma with metastases leading to severe challenges in management. A 50-year-old female patient was presented to the gynaecologist in February 2007 with complaints of menorrhagia. An ultrasound of abdomen not only confirmed a fibroid of the uterus but also showed a doubtful shadow in the left adrenal gland. This was followed with a CT scan that showed an adrenal adenoma of 3.5 × 3 cm with no adjoining lymphadenopathy or ascites. The patient was normotensive and her serum potassium was normal. She was referred to us for evaluation and we proceeded to do further investigations. Her overnight dexamethasone suppression tests showed a serum cortisol of 71 nmol/l but a 24 h urine-free cortisol and urine catecholamines was normal on three occasions, which was performed over a period of 1 month. An aldosterone renin ratio was estimated after appropriate measures and this confirmed a normal value as …