Approximately 10% of pheochromocytomas are familial, associated with neuroectodermal disorders (von Hippel-Lindau disease, von Recklinghausen's disease, tuberous sclerosis, Sturge-Weber syndrome or Carney's syndrome) or as a part of hereditary multiple endocrine neoplasia (MEN) 2A and 2B. 

In MEN-2, bilateral adrenal medullary hyperplesia (diffuse or nodular) is almost always present and precedes pheochromocytoma, which develops in 30–50% of patients. Pheochromocytomas are usually multicentric and bilateral in up to 50–80% of cases with long term follow-up. They are rarely extra-adrenal or malignant.

Pheochromocytomas associated with neuroectodermal disorders are most common in von Hippel-Lindau disease, occurring in approximately 25% of patients. They are often bilateral and rarely extra-adrenal except in Carney's syndrome, which is associated with functioning extra-adrenal paraganglioma. All patients with “sporadic” pheochromocytoma should be screened for MEN-2 and van Hippel-Lindau disaese.

“The majority of LATs were still benign, but they had a higher probability to be malignant. Benign LATs made up 68.13% of all cases, mainly adrenal cysts (19.52%), pheochromocytoma (18.73%), benign adenoma (16.73%), and myelolipoma (7.17%). Malignant LATs accounted for 28.69% of cases, mainly including adrenocortical carcinoma (8.76%) and metastases (17.13%). Laparoscopic surgery was found to involve less trauma than open surgery. It was also safer and postoperative recovery was faster, but it had drawbacks and could not completely replace open surgery. CT features had obvious specificity for the diagnosis of benign and malignant tumors.”
Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases). 
Zhang Z et al. 
World J Surg Oncol. 2019 Dec 16;17(1):220.

”CT features had obvious specificity for the diagnosis of benign and malignant tumors. For example, benign adenomas had a smaller pre-contrast (< 10 Hu) whereas malignant adrenal tumors had, on the contrary, higher attenuation. Regarding adrenal malignant carcinoma, adrenal primary malignant tumors showed a better prognosis than adrenal metastases (mean survival of 19.17 months vs 9.49 months). Primary adrenal cortical carcinoma without metastasis had a better prognosis than primary adrenal cortical carcinoma metastasis (mean survival of 23.71 months vs 12.75 months), and adrenal solitary metastasis had a better prognosis than general multiple metastatic carcinoma (mean survival of 14.95 months vs 5.17 months).”
Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases). 
Zhang Z et al. 
World J Surg Oncol. 2019 Dec 16;17(1):220.