Bilateral primary adrenal lymphoma presenting with adrenal insufficiency.

[adrenal incidentaloma]

Lymphoma may occasionally involve the adrenal glands , but primary adrenal lymphoma (PAL ) is very rare and only few cases have been reported . We present a case of a 60 -year -old , otherwise healthy , woman , with bilateral PAL presenting with adrenal insufficiency . The patient responded initially upon administration of large doses of intravenously hydrocortisone with total remission of symptoms . An abdominal computerized tomography scan demonstrated bilateral adrenal lesions but did not demonstrate any other pathology . Since metastatic malignant disease was suspected a positron-emission-tomography scan was performed only showing significant uptake in the adrenal glands . Endocrine evaluation did not reveal abnormal function of any hormonal system and the patient was scheduled for bilateral adrenalectomy . However the clinical condition deteriorated rapidly and the patient was readmitted to hospital before surgery was performed . A new computerized tomography scan showed rapid progression of disease with further enlargement of the adrenal masses and both pulmonary and hepatic metastasis . Needle biopsy was performed but the patient refused further treatment and died before a diagnosis was obtained . The immuneohistochemical diagnosis was large B-cell lymphoma . This case should remind clinicians that PAL may be a cause of bilateral adrenal incidentaloma especially if the patient presents with adrenal insufficiency .