Bilateral Adrenal Masses With Rapid Deterioration: A Rare Case of Primary Adrenal Lymphoma
https://doi.org/10.15605/jafes.041.S1
- Author:
Melody Tsen Shu Ling
1
;
Cheong Yee Weai
2
;
Hwee Ching Tee
2
;
Jin Hui Ho
2
;
Shireen Siow Leng Lui
2
Author Information
1. Department of Medicine, Hospital Queen Elizabeth
2. Diabetes & Endocrine Unit, Department of Medicine, Hospital Queen Elizabeth II
- Publication Type:Journal Article
- MeSH:
Lymphoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):26-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Primary adrenal lymphoma (PAL) is a rare extranodal
lymphoma, accounting for less than 1% of cases. It often
presents with non-specific constitutional symptoms
and features of adrenal insufficiency. The absence of
pathognomonic findings frequently leads to delayed
diagnosis, by which time the disease is often advanced,
contributing to poor prognosis.
Case:A 59-year-old male with type 2 diabetes mellitus and
previously treated pulmonary tuberculosis presented with
1 month of lethargy, anorexia, weight loss, and abdominal
pain. He was cachectic but hemodynamically stable
(BP 120/81 mmHg; glucose 5.1 mmol/L), with otherwise
unremarkable systemic examination. Laboratory evaluation
revealed hyponatremia (120 mmol/L), hyperkalemia (6.0
mmol/L), and severe hypercalcemia (4.4 mmol/L). A short
Synacthen test confirmed adrenal insufficiency.
Computed tomography demonstrated marked bilateral
adrenal enlargement with bulky masses (8.9 × 8.7 × 8.7
cm right; 9.9 × 7.6 × 10.2 cm left), suggestive of malignant
infiltration. Adrenal protocol imaging revealed indeterminate lesions with attenuation >40 Hounsfield Unit and
relative washout <40%. Ultrasound-guided biopsy of the
right adrenal gland was performed.
The patient was discharged on hydrocortisone replacement
with plans for early follow-up. One week later, he presented
again in adrenal crisis with severe hypoglycemia (1.1
mmol/L) and cardiovascular collapse. Despite resuscitative
efforts, he succumbed. Histopathology subsequently
confirmed diffuse large B-cell lymphoma, activated B-cell
subtype, consistent with PAL.
Conclusion:This case highlights the diagnostic pitfalls of PAL,
particularly when constitutional symptoms mimic chronic
infections such as tuberculosis. It underscores the need for
high clinical suspicion in patients with bilateral adrenal
masses and adrenal insufficiency. Early recognition,
adequate steroid replacement including mineralocorticoid therapy, and prompt tissue diagnosis are critical to prevent
rapid deterioration and improve outcomes.
- Full text:2026072813472320961EP_A014.pdf
