Primary adrenal carcinoma is an extremely rare malignancy with an estimated incidence of 1 in 1.7 million. Several surgical approaches have been described, and with most recent trends toward minimally invasive surgery, laparoscopic adrenalectomy has become widely accepted. The most notable relative exception to laparoscopic adrenalectomy might be an excessively large tumor (>8 cm) or in a patient with a pheochromocytoma, as manipulation of the adrenal gland could induce a catecholamine surge and subsequent hypertensive crisis. We report a case of primary left adrenal aldosterone-producing carcinoma which was removed laparoscopically without complications. Our patient is a 43 year old Caucasian male who presented to UTMB Galveston's emergency department with complaints of headache and weakness. He denied any heart palpitations, sweating, and he did not display any cushingnoid features. The patient was found to be hypertensive (SMP 190-220 mmHg and DBP 90-108 mmHg), and initial serum chemistry revealed severe hypokalemia. (2.4 mMol/L) He underwent a complete work up for his hypertensive crisis and suspected hyperaldosteronism. Serum and urine studies indicated an elevated serum aldosterone (26.6 ng/dl) with a low serum renin (<0.1 ng/ml/hr). His catecholamine and cortisol studies were normal. A CT scan and MRI revealed an enlarged nodular heterogeneous left adrenal gland with small calcifications measuring 4.3 cm. Since this mass showed no change in signal intensity on in and out phase MR imaging, it was not considered an adenoma. The patient underwent a cardiac evaluation, and he was started on potassium supplements, spironolactone, and clonidine preoperatively for 2 weeks, which resulted in correction of his hypokalemia but only marginal control of his hypertension. He was informed of the risks and benefits of left laparoscopic adrenalectomy and underwent the procedure without complication or exacerbation of hypertension. Postoperatively, he developed an ileus which quickly resolved with correction of his hypokalemia, and he was discharged home on the third postoperative day. The final pathology report revealed an adrenal cortical tumor of uncertain malignant potential. Histological features were consistent with an adrenal carcinoma such as focal necrosis, areas of hemorrhage, focal atypia, broad fibrous bands separating the tumor, low mitotic activity (5 mitosis per 50 hpf), and areas suspicious for capsular invasion. Immunohistochemical staining was strongly positive for vimentin suggesting an adrenal carcinoma. On follow up, the patient was doing well without further need of spironolactone or potassium supplement. His blood pressure remains well controlled with clonidine alone. The histological diagnosis of adrenal malignancies can be challenging in this uncommon cancer. Though a variety of surgical approaches exist, we recommend a transperitoneal laparoscopic approach for the removal of most adrenal tumors after careful preoperative evaluation and patient preparation.