Adrenal lymphoma presenting as primary hypoadrenalism in the elderly

Abstract

Adrenal lymphoma causing primary hypoadrenalism in the elderly is a very rare finding. We describe a case of an 85-year-old man who was admitted to our hospital. He had a short history of hypotension and unresponsiveness. He was referred to the endocrine team, after a CT scan of his thorax abdomen and pelvis demonstrated significant enlargement of both his adrenal glands with associated lymphadenopathy. This scan was originally done to rule out an occult intra-abdominal malignancy. In addition, a tetracosactide (short Synacthen) test demonstrated adrenal insufficiency. This case demonstrates that adrenal lymphoma should be considered as an important differential when there is evidence of adrenal gland hyperplasia, lymphadenopathy and adrenal insufficiency.

Primary adrenal insufficiency masking as an adrenal B-cell lymphoma

“…Majidi et al finally concluded that there is significant heterogeneity in the manifestation of primary adrenal lymphoma. 7 …”

“…Majidi et al finally concluded that there is significant heterogeneity in the manifestation of primary adrenal lymphoma. 7 Primary adrenal lymphoma has been characterised as either unilateral or bilateral lymphoma in a patient without a medical history of lymphoma elsewhere and with the adrenals being the predominantly involved organ. 7 About 70% of cases of primary adrenal lymphoma are bilateral.…”

“…7 Primary adrenal lymphoma has been characterised as either unilateral or bilateral lymphoma in a patient without a medical history of lymphoma elsewhere and with the adrenals being the predominantly involved organ. 7 About 70% of cases of primary adrenal lymphoma are bilateral. With unilateral involvement, PAL can present with insufficiency, weight loss, night sweats and fever.…”

“…However, insufficiency is more typical of bilateral gland involvement. [7][8][9] PAL has a male to female predominance of 2:1 and typically occurs in the elderly, with a median age of 68 years. 10 11 Diffuse large B-cell is the most common type of lymphoma in the United States (30% of cases) and also constitutes the majority of primary adrenal lymphomas.…”

“…Our patient reported fatigue, back pain, weight loss, but no significant abdominal pain or hyperpigmentation. Majidi et al finally concluded that there is significant heterogeneity in the manifestation of primary adrenal lymphoma 7…”