Endocrine Abstracts

Primary adrenal lymphoma is a rare cause of adrenal insufficiency, accounting for only approximately 1% of non-Hodgkin lymphoma cases. Most common subtype of PAL is diffuse large B cell lymphoma. A 71-year-old gentleman with the past history of hypertension, type 2 DM and the incidental finding of adrenal hyperplasia, presented with the general ill health with lethargy, weight loss and reduced appetite. He has the past history of hypertension, type 2 DM and the incidental finding of adrenal hyperplasia. Examinations were unremarkable apart from the signs of dehydration and postural hypotension. Initial investigations showed normocytic anaemia of Hb 70g/l, hyponatraemia with Na level of 128 mmol/l. A short synthacth test revealed adrenal insufficiency. CT scan showed bilateral adrenal haemorrhages on a background of pre-existing adrenal hyperplasia. Given the engulfing nature of the left-sided haematoma underlying lymphoma cannot be excluded. Treatment with glucocorticoid and mineralocorticoid hormone replacement therapy was started. A subsequent FDG/PET showed intensely hypermetabolic disease in both adrenal glands further soft tissue disease in the retroperitoneum and mesentery. Appearances are in keeping with an aggressive lymphoma for proliferative disorder. CT guided left adrenal mass biopsy was done which revealed high grade diffuse B-cell Non-Hodgkin lymphoma (DLBCL). R-CHOP chemotherapy was planned by consulting haematology.