Adrenal cortical tumors are rare with a frequency of 1–2 per million and are mostly sporadic, but can be associated with several syndromes, the most common ones being multiple endocrine neoplasia type I (MEN-I), Li-Fraumeni syndrome, Carney complex, and Beckwith-Weidemann syndrome. The majority of tumors are usually large at presentation (typically over 6 cm), and have areas of degeneration and necrosis, with calcification. Heterogeneous enhancement is typically seen with IV contrast administration. Tumor extension into the inferior vena cava is an uncommon occurrence. They can either present as hyperfunctioning or nonfunctioning tumors. When they are hyperfunctioning, patients usually present with Cushing syndrome, and less commonly with virilization, and feminization. Nonfunctioning tumors are usually very large at presentation [30–32].