Endocrine Abstracts

An 82 year old man was admitted to hospital with lethargy, anorexia and back pain. His past medical history included chronic lymphocytic leukaemia and hypertension. Blood tests revealed a serum sodium of 115 mmol/l and potassium of 5.4. His irbesartan was discontinued and sodium rose to 126 prior to discharge. 9 am cortisol was 408 nmol/l. He was readmitted to hospital 6 days later with hyponatraemia (116 mmol/l). A short Synacthen test was performed which showed a flat response (baseline cortisol 282 nmol/l with a 60 minute post-Synacthen level of 265). ACTH level on the baseline sample was raised at 400 pg/ml. He was commenced on hydrocortisone replacement therapy and felt much improved. A CT scan of the abdomen showed large bilateral adrenal masses (4.9×3.5 cm on the right, 9.2×6 cm on the left), small para-aortic lymph nodes and multiple hepatic metastases. A subsequent biopsy of the left adrenal mass showed features consistent with a high grade B-cell non-Hodgkin’s lymphoma.

The incidence of adrenal involvement in non-Hodgkin’s lymphoma is estimated to be between 0.8–2%. Although autoimmune adrenalitis is the most common cause for primary adrenal insufficiency in the developed world, malignancy should be considered as an underlying cause, especially in the elderly.