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Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 9-11

Primary adrenal insufficiency secondary to bilateral adrenal lymphoma

1 Department of Internal Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
2 Department of Histopathology, Qatif Central Hospital, Qatif, Saudi Arabia

Correspondence Address:
Dr. Zahra Abdulkareem Ghareeb
Department of Medicine, Qatif Central Hospital, Qatif
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdep.jdep_18_19

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Involvement of adrenal glands in lymphoma is rare; the patient may have variable presentations. We report a case of a 62-year-old Saudi female who presented to our center with a few-week history of fatigue, weight loss, subjective fever, and a recent change in skin color. On examination, she looked dehydrated and had a drop in blood pressure with postural change and hyperpigmentation of the skin of the face and hands. Morning cortisol levels were low, and adrenocorticotropic hormone levels were high, which indicated primary adrenal insufficiency (PAI). An adrenal computed tomography (CT) scan revealed bilateral adrenal enlargement. After excluding pheochromocytoma, a CT scan-guided trucut biopsy of the adrenals confirmed non-Hodgkin lymphoma. The patient was started on steroid replacement therapy, and after stabilization, a plan was made to initiate chemotherapy for the treatment of lymphoma; unfortunately, the patient died shortly after diagnosis because of rapid progression of the disease. Adrenal lymphoma can present with PAI and should be considered in the presence of bilateral adrenal enlargement; it is an aggressive tumor and carries poor prognosis if the treatment is delayed.

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