Endocrine Abstracts

Adrenal gland anomalies are common incidental findings when imaging tests are performed for other reasons, but are usually unilateral. We present a case where bilaterally abnormal adrenal glands held the key to a rare diagnosis. A 79 year old female ex-smoker with a background of Type 2 Diabetes Mellitus and hypertension presented to our emergency department with a four month history of falls and progressive decline in mobility. Examination revealed evidence of weight loss, with grade 3/5 power and hyporeflexia in both lower limbs. She was hyponatraemic (sodium 117 mmol/L), attributed to taking bendroflumethiazide and amitriptyline, and anaemic with a detectable paraprotein. Early morning cortisol was within acceptable limits (665 nmol/L). Spinal imaging revealed degenerative disc disease, a small lung nodule and bilateral adrenal enlargement (5 cm). Nerve conduction studies confirmed a large fibre sensorimotor axonal abnormality. Suspecting metastatic bronchial malignancy, the patient eventually underwent adrenal biopsy which gave the diagnosis of Primary Adrenal Lymphoma (of diffuse large B cell type). After a short trial of chemotherapy she unfortunately deteriorated and died within 6 weeks of diagnosis. Primary adrenal lymphoma is a very rare form of extranodal non-Hodgkin’s disease, with <200 cases reported worldwide. It is usually bilateral, highly aggressive and associated with primary adrenal failure. Lymphoma should be considered in the differential diagnosis of adrenal lesions, particularly when bilateral.