A 67-year-old woman with prior right adrenalectomy for pheochromocytoma (2021; clear margins, low proliferation) presented in 2025 with elevated plasma metanephrines. F-18-DOPA PET/CT revealed a low-attenuating, DOPA-avid lesion in the left adrenal gland, suspicious of a pheochromocytoma. To avoid adrenal insufficiency, multidisciplinary evaluation favored EUS-guided radiofrequency ablation as an organ-preserving approach. EUS-RFA was performed using a dedicated system (EUSRA, Taewoong Medical, South Korea), with three energy applications. A transient hypertensive response occurred (systolic BP to 240 mmHg), successfully managed with vasodilators. The patient remained hemodynamically stable and was discharged the next day after uneventful recovery. This represents one of the first reported uses of EUS-RFA for this indication. Biochemical and radiologic follow-up outcomes will be presented at the conference.