Endocrinology Research and Practice
Case Report

Symptomatic Adrenal Insufficiency due to Bilateral Adrenal Non-Hodgkin’s Lymphoma

1.

Hacettepe University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey

2.

Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey

3.

Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey

Endocrinol Res Pract 2016; 20: 108-110
DOI: 10.4274/tjem.3104
Read: 2216 Downloads: 626 Published: 01 September 2016

ABSTRACT

Secondary involvement of the adrenal gland with non-Hodgkin’s lymphoma has been reported to occur in up to 25% of patients during the course of the disease. A 45-year-old man presented with a several month history of nausea, fatigue and weight loss. His medical history was unremarkable. Abdominal computed tomography (CT) was performed and showed bilateral adrenal massive masses measuring 10x7.5 cm on the left and 4.8x4 cm on the right. He developed adrenal insufficiency in the follow-up period. The patient was started on replacement dose of prednisolone. A positron emission tomography-CT scan was acquired for further staging of the disease and showed intense fluorodeoxyglucose accumulation in both adrenal glands, additionally a slight fluorodeoxyglucose accumulation was observed in the ileocecal site. He did not accept  adrenal biopsy or surgery. Histopathological examination of the ileocecal site revealed diffuse large B-cell lymphoma. He was administered rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. Bilateral adrenal lymphoma is a rare entity when compared with the incidence of adenoma and adrenal metastases of other cancers. Adrenal insufficiency may be the primary symptom of presentation, especially with bilateral involvement as in bilateral adrenal lymphoma.

 

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