Endocrine Abstracts

Primary adrenal lymphoma is an extremely rare type of lymphoma. There have been only about 200 cases described in the literature so far. About a half of patients can present with adrenal insufficiency. We report a case of a 70- year-old previously fit and well patient referred to Endocrinology services after a CT scan of her adrenal showed bilateral adrenal masses right measuring 6 cm and left measuring 9 cm. CT was performed as she complained of 9 kilograms weight loss in last three months. She denied any other symptoms. Later on, she did complain of some night sweats. Clinically, she had no sinister signs. She had a new hyponatremia 127 mmol/l (135-145), Lactate dehydrogenase of 1009 U/l (0-479) and B2- microglobulin of 3.4 mg/l (1.1-2.5) Blood metadrenalines, urine steroid profile, and 17 OH progesterone was normal. 9 am cortisol was 568 nm/l (140-620) ruling out adrenal insufficiency. She underwent a CT guided biopsy. Histology was consistent with a diagnosis of Diffuse Large B cell Lymphoma. 70 % of PAL’s are Diffuse Large B cell Lymphomas. The prognosis of Primary Adrenal lymphoma remains very poor. Chemotherapy remains the mainstay of treatment. Little is known about the chemotherapy regimen, the rate of relapse, and the role of adrenalectomy. Adrenal lumps can be a sign of pathology relating to other body systems such as a haematological malignancy in this case. Haematological malignancy pathways need to be revisited. Adding LDH as a tumour marker can be of value and can help redirect early referral to the right speciality.