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Case Reports in Endocrinology
Volume 2012 (2012), Article ID 638298, 3 pages
http://dx.doi.org/10.1155/2012/638298
Case Report

Bilateral Primary Adrenal Lymphoma Presenting with Adrenal Insufficiency

1Department of Medicine, Endocrine Unit, Koege Hospital, University of Copenhagen, 4600 Koege, Denmark
2Department of Pathology, Roskilde Hospital, University of Copenhagen, 4000 Roskilde, Denmark

Received 17 June 2012; Accepted 8 August 2012

Academic Editors: G. Aimaretti and K. Iida

Copyright © 2012 Jakob Holm et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lymphoma may occasionally involve the adrenal glands, but primary adrenal lymphoma (PAL) is very rare and only few cases have been reported. We present a case of a 60-year-old, otherwise healthy, woman, with bilateral PAL presenting with adrenal insufficiency. The patient responded initially upon administration of large doses of intravenously hydrocortisone with total remission of symptoms. An abdominal computerized tomography scan demonstrated bilateral adrenal lesions but did not demonstrate any other pathology. Since metastatic malignant disease was suspected a positron-emission-tomography scan was performed only showing significant uptake in the adrenal glands. Endocrine evaluation did not reveal abnormal function of any hormonal system and the patient was scheduled for bilateral adrenalectomy. However the clinical condition deteriorated rapidly and the patient was readmitted to hospital before surgery was performed. A new computerized tomography scan showed rapid progression of disease with further enlargement of the adrenal masses and both pulmonary and hepatic metastasis. Needle biopsy was performed but the patient refused further treatment and died before a diagnosis was obtained. The immuneohistochemical diagnosis was large B-cell lymphoma. This case should remind clinicians that PAL may be a cause of bilateral adrenal incidentaloma especially if the patient presents with adrenal insufficiency.