A 50-year-old man with a history of hypertension presents to the emergency department with sudden-onset severe left flank pain radiating to the left groin, nausea, and diaphoresis. He reports no prior episodes of headache, palpitations, or perspiration at rest. Vital signs: BP 82/48 mmHg, HR 115 bpm, RR 22/min, T 37.2°C. Physical examination reveals left costovertebral angle tenderness and diminished breath sounds at the left base. Laboratory studies show hemoglobin 9.2 g/dL (previously 14.1 g/dL 6 months ago), WBC 13,200/μL, sodium 138 mEq/L, potassium 4.9 mEq/L, pH 7.32 with mild metabolic acidosis, and negative urine dipstick. Noncontrast CT abdomen demonstrates a 6 cm left adrenal mass with acute hemorrhage; no renal artery dissection or thrombosis is noted. Which of the following is the most likely diagnosis?

1. A)Hemorrhagic infarction of a pheochromocytoma
2. B)Rupture of an adrenocortical adenoma with acute bleedingGABARITO
3. C)Acute renal infarction with secondary adrenal hematoma
4. D)Adrenocortical carcinoma with spontaneous hemorrhage and necrosis
5. E)Acute meningococcemia with bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome)