EUS-guided radiofrequency ablation (EUS-RFA) can be used for any lesion near the gut, such as left adrenal gland (LAG) is. Its goals are organ preservation and surgery complications avoiding.

We present the case of a 57 years-old male with neurofibromatosis type 1, prior right adrenalectomy and a metachronous 12x10mm LAG pheochromocytoma successfully treated by EUS-RFA. Following proper premedication, the procedure was done under general anesthesia and ablation was carried out with four 10-second/60W shots of EUSRA^TM 19G device.

Patient suffered a catecolaminergic crisis after the second ablation shot (SBP:260 mmHg/ HR:120 bpm) successfully controled, with no other immediate or delayed complications. At one year follow-up catecolamine levels remain normal and no lesion can be seen in LAG on CT-scan.