This patient had a known history of congenital adrenal hyperplasia after presenting with Addison disease at birth. Her congenital adrenal hyperplasia had been poorly controlled with the patient lost to follow-up. The adrenal changes are typical with background adrenal limb thickening with numerous adrenal masses and nodules, some containing macroscopic fat - these likely represent a combination of nodular hyperplasia, adenomas and myelolipomas.