Patient is a 23-year-old male with MENIIB, RET 918 positive, who presented with the finding of a new right adrenal mass on PET-CT. His past medical history was significant for bilateral medullary thyroid carcinoma, for which he underwent a total thyroidectomy. Post-operatively, his calcitonin levels remained stably elevated at around 50 pg/mL, with no clinical or radiographic evidence of recurrent disease for over a decade. However, recently his serum calcitonin levels rose, and a PET-CT scan was obtained, which discovered a 3cm right adrenal lesion. Simultaneous laboratory analysis demonstrated elevated plasma metanephrines (489 pg/mL) and normetanephrines (740 pg/mL), confirming the diagnosis of pheochromoctyoma. Additionally, the patient had a history of asymptomatic pan - colonic megacolon with massive dilation of the hepatic flexure up to 15cm. Multidisciplinary discussion determined that his megacolon did not require treatment and that if a trans-abdominal surgery were to be performed, total abdominal colectomy might be required for safe closure of the abdomen. The patient underwent an uneventful retroperitoneoscopic adrenalectomy. Pheochromocytoma was confirmed on final pathology. The patient was discharged home post-operative day one without complications. He has continued to do well post-operatively, and his metanephrines have normalized.