Abstract: In cases of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome with bilateral adrenal tumors, the preoperative accurate localization of the dominant side of secretion remains a challenge. Currently, adrenal venous sampling (AVS) is considered an optional subtyping method in clinical practice, while non-invasive imaging techniques such as ⁶⁸Ga-pentixafor positron emission tomography (PET)/CT have garnered significant attention for their potential in identifying cortisol-producing adenomas. This article summarizes two cases of ACTH-independent Cushing's syndrome with bilateral adrenal tumors in which ⁶⁸Ga-pentixafor PET/CT-assisted localization led to misdiagnosis. By analyzing their clinical characteristics and discussing key diagnostic points, it aims to provide clinical insights for the management of patients with ACTH-independent Cushing's syndrome and bilateral adrenal tumors.