Endocrine Abstracts

Objective

There is limited clinical data available on bilateral adrenal masses (BAM). Here we present a case with BAC and adrenal insufficiency. The patient’s lesions disappeared after steroids, re-grew in the follow-up, allowing a biopsy.

Case

A 60-year-old male patient presented with abdominal pain, nausea, and weakness to another hospital. Hyponatremia and hyperkalemia accompanied by hypotension were detected. Abdominal tomography revealed, “irregularly demarcated hyperdense mass lesions, 60 × 44 mm in the right and 75 × 26 mm in the left adrenal.” Upon referral to our hospital, we employed PET-CT, which demonstrated “mass lesions of 49 × 52 × 71 mm in the right and 56 × 57 × 75 mm in the left adrenal as well as pathological hypermetabolism in multiple foci in the skeletal system.” After diagnosing adrenal insufficiency, we initially gave the patients intravenous hydrocortisone, followed by oral maintenance. There were no pathological findings in tuberculosis tests, viral and autoimmune panel, and malignancy screening. Urine and plasma catecholamine and 17-hydroxy progesterone levels were normal. CT-guided biopsy of the adrenal mass revealed fat necrosis. After 45 days, we attempted a repeat biopsy without success due to almost wholly regressed adrenal masses. Also, bone lesions could not be visualized. Adrenal MRI showed “14 mm lesion on the right and, only diffuse thickening on the left adrenal.” A control PET-CT was obtained. “Evident decrease in the size of the adrenal lesions, in addition to the fairly reduced metabolic activity of adrenal masses and bone lesions.” We performed a biopsy from the most active bony lesion; however, it was inadequate. Two months after the initial presentation, he was admitted with abdominal pain. His lesions had progressed. In CT he had, 70 × 41 mm right adrenal mass invading liver and IVC, 56 × 38 mm left adrenal mass, and numerous metastasis in his liver and lungs. Adrenal biopsy, this instance was compatible with “CD20 + B cell lymphoma infiltration.” Patient died of cerebrovascular incident, whilst awaiting biopsy results.

Conclusion

Primary adrenal lymphoma is a rare etiological cause of BAM with only a handful of reported cases. Adrenal lesions vanishing after steroids should raise the suspicion of adrenal lymphoma. The shrinkage of tumors may lead to diagnostic difficulties such as our patient.