Abstract

Background: Primary adrenal lymphoma is a very rare condition. It usually occurs as a bilateral adrenal
mass. Patients usually do not have disease elsewhere what makes the diagnosis more difficult. The symptoms of disease are variable and depend on the presence of adrenal insufficiency, tumor size or lymphoma.
Case Report: We report a case of a 66-year-old woman who was evaluated due to anorexia and epigastric pain.
She was admitted to the Department of Endocrinology due to an incidental discovery of a large, bilateral adrenal mass. There was no history of weight loss, fever or night sweating. Physical examination revealed pale skin, orthostatic hypotension, splenomegaly without hepatomegaly and no abnormalities in the chest, head and neck. No peripheral lymph nodes were palpable. Results of dynamic hormonal tests confirmed the clinical diagnosis of adrenal insufficiency. During the observation tumors enlarged markedly. Adrenal hemorrhage or lymphoma was initially suspected. The result of a percutaneous needle biopsy of the right adrenal gland was inconclusive and no infiltration of lymphoma in the bone marrow led to the decision of an
adrenalectomy. The histopathological result was a diffuse large B cell lymphoma. Systemic
chemotherapy was initiated with CHOP regimen.
Conclusions: In the presence of bilateral rapidly growing adrenal mass, adrenal insufficiency, splenomegaly and no peripheral lymphadenopathy the diagnosis of primary adrenal non Hodgkin lymphoma
has to be taken into account.

Keywords: adrenals, adrenal insufficiency