Primary Adrenal Lymphoma Presenting with Adrenal Failure: A Case Report and Review of the Literature

Primary adrenal lymphoma is rare, with a few cases reported in the literature. Most often it manifests as bilateral adrenal lesions and adrenal insufficiency is a common complication.
A 53-year-old male was referred with abdominal discomfort and darkening of the skin since 1 month prior to admission. His workups detected large bilateral adrenal masses. The patient was admitted due to hypotension, and was diagnosed with adrenal insufficiency. Laboratory studies showed high erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and adrenocorticotropin levels. There was no other organ involvement and computed tomography (CT)-guided percutaneous biopsy of the adrenal gland revealed B-cell type of non-Hodgkin lymphoma. Replacement therapy with glucocorticoid and mineralocorticoid was initiated with remission of symptoms. After 3 months of chemotherapy his condition improved, but the patient worsened thereafter and died 2 months later.
However, this case reminded the importance of considering primary adrenal lymphoma in the differential diagnosis of bilateral adrenal masses, especially if the patient presents with adrenal insufficiency.