Endocrine Abstracts

Adrenal lesions are commonly detected incidentally during cross-sectional imaging examinations, and the majority are benign adrenal adenomas. A 52 year old gentleman with a history of hypertension and paroxysmal atrial fibrillation was referred to our service following a fall in which he fractured several ribs. Subsequent abdominal CT revealed an incidental finding of bilateral adrenal masses, reported as approximately 5 cm and 4 cm on the right and left side respectively with a density on the unenhanced scan. On further questioning he reported problems with fatigue and weight gain. Endocrine tests to assess adrenal functionality were negative. Three months later, repeated adrenal CT showed his adrenal lesions had significantly decreased in size without any treatment. The right adrenal gland measuring 4.5×2.8×2.7 cm (previously 5×4.2×4.1 cm) and the left adrenal gland measuring 3.7×3.5×3.4 cm (5.6×5.2×4.6 cm). Soon afterwards, he presented to the Emergency Department with fatigue, weakness and dizziness on standing. He was pancytopenic and short adrenocorticotrophic hormone stimulation test revealed adrenal insufficiency. He was commenced on hydrocortisone (20 mg + 10 mg + 10 mg daily) and fludrocortisone (50 mcg). His case was reviewed in the Adrenal multi-disciplinary meeting. Histology from a subsequent adrenal biopsy showed diffuse large B cell lymphoma with a Ki-67 of approximately 80%. The patient was administered R-CODOX-M (rituximab–cyclophosphamide, doxorubicin, vincristine and Methotrexate) chemotherapy. He was re-evaluated on completion of his chemotherapy cycles (2 cycles) with a non-contrast CT scan revealed complete resolution of the previously detected bilateral adrenal masses. It is important to get a histological diagnosis from indeterminate adrenal lesions to ensure adequate treatment, as diagnoses of adrenal lymphoma are <1% of the Primary extranodal non-Hodgkin lymphomas cases. The case exhibited unusual presentation of fluctuating bilateral adrenal lymphoma with an excellent response to the chemotherapy, as shown by complete resolution in the sizes of both adrenal glands. This case complements the few other reported cases in the literature regarding diffuse large B cell lymphoma with adrenal insufficiency that showed a complete response to chemotherapy. He has now reduced his dose of hydrocortisone (15 mg + 10 mg+5 mg). Can adrenal function recover after treating adrenal lymphoma?