Endocrine Abstracts

Introduction: Non-Hodgkin’s lymphoma is an AIDS defining malignancy. However, a primary adrenal lymphoma as a presenting feature of HIV infection has not been previously reported.

Case Report: A 66-year-old male presented with a short history of severe fatigue, weight loss, dizziness and nausea. Baseline blood results revealed normal biochemistry with mild normocytic anaemia, neutropaenia with lymphopaenia and the short synacthen test demonstrated intact HPA axis (baseline cortisol 348 nmol/l, 30 min 607 nmol/l, 60 min 632 nmol/l). Upper and lower GI endoscopies as well as CT abdomen showed no significant pathology.

Three months later he presented acutely with extreme fatigue, vomiting, hypotension and hyponatraemia of 123 mmol/l. His short synacthen test was repeated which demonstrated sub-optimal response with baseline cortisol 298 nmol/l, 30 min 353 nmol/l and 60 min 439 nmol/l. Steroid replacement therapy resulted in significant clinical improvement. The CT abdomen was repeated which revealed bilaterally enlarged, well defined homogenous adrenal masses measuring 6 cm each, which were non-secretory on endocrine testing.

Three weeks later, a pre- biopsy imaging showed 70% reduction in adrenal volume, possibly due to steroid therapy. Laparoscopic right adrenelectomy and biopsy confirmed diffuse large B-cell lymphoma. Further investigations confirmed the patient was HIV positive with the CD4 count of 1 per microlitre and the clinical course was complicated by CMV retinitis. Despite the chemotherapy with incorporated HAART, the course of the disease has been complicated by the subsequent development of cerebral lymphoma.

Conclusion: HIV-associated lymphoma is most commonly diagnosed in patients with advanced HIV, a low CD4 count (often <100/μl), high HIV viral load, and a prior diagnosis of AIDS.

We present this unusual case of primary adrenal lymphoma presenting with adrenal insufficiency which posed a diagnostic challenge.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.