VHL and metastatic neoplasm: Genetic testing preoperatively can be helpful to inform the surgical approach, as cortical-sparing adrenalectomy is preferred in younger patients to reduce the risk of adrenal insufficiency (and requirement for exogenous steroids) and does not seem to increase the risk of recurrence for patients with mutations in VHL, RET, or NF1, but in patients with higher risk for metastatic disease, such as those with SDHB mutations, more extensive resection may be needed (21).