Endocrine Abstracts

Endogenous Cushing’s syndrome is a rare disease, with an incidence of 0.7–2.4 per million people per year. Adrenal origin is described in approximately 20 percent of all cases. Adrenal lymphoma presenting as adrenal incidentaloma with autonomous cortisol production has recently been described, though this is a rare condition. We report a rare case of adrenal Cushing’s syndrome in a patient diagnosed with a low-grade non-Hodgkin’s lymphoma. Female patient, age 53, was diagnosed in 2018 with low grade follicular lymphoma (biopsy from a inguinal adenopathy) with no indication of hematological treatment. The patient had multiple CT scans in the follow up of her lymphoma; which revealed a left heterogeneous adrenal mass of 29/32 mm; relatively stable since 2018. Recently she presented to the endocrinology department with a history of progressive weight gain of approx. 10 kg in the last year, hypertension, dyslipidemia, decreased muscle strength and right leg pain with recent swelling; At presentation she had facial plethora, central obesity with a BMI of 36 kg/m²; moon face, bilateral varicose veins with signs of thrombosis in the right lower leg. Diagnosis of Cushing’s syndrome was based on demonstrating hypercortisolism, disturbed circadian rhythms of salivary a cortisol and non-suppressible cortisol by a low dose dexamethasone suppression test (LDST). ACTH and DHEAS levels were low, which confirmed the adrenal origin. CBC was normal and HBA1C was 5.8%. Plasmatic metanephrines and normetanephrines were normal. The venous doppler revealed right saphenous vein thrombosis and the patient was commenced on oral anticoagulants. Two months later, right laparoscopic adrenalectomy was performed with intra and postoperative glucocorticoid replacement. The pathology report is in progress. Very few cases of lymphoma and Cushing’s syndrome are described in literature and some report Cushing’s masking the diagnosis of Lymphoma with progression of hematological disease following treatment of Cushing’s syndrome. In conclusion, if immunohistochemical analysis for steroidogenesis enzymes expression in neoplastic B-cells will be demonstrated this would require a personalized approach for the succesful management of the patient with Cushing’s syndrome.