Adrenal Insufficiency Due to Bilateral Adrenal Non-Hodgkin's Lymphoma: A Case Report

Abstract

Primary adrenal insufficiency is a rare condition due to the impairment of adrenal glands. Previously, tuberculosis damaging adrenal glands was attributed as the main cause for it; whereas, nowadays autoimmune disease is the most common cause of it. However, rarely metastatic malignancy can cause adrenal insufficiency as well. This is a case report of a 72-year-old who presented with a three-month history of being generally unwell. Investigations showed bilateral adrenal masses with a positive short synacthen test (SST) for adrenal insufficiency. Adrenal insufficiency was managed with hydrocortisone and fludrocortisone while the biopsy showed diffuse large B-cell lymphoma (DLBCL). He underwent positron emission tomography/computed tomography (PET/CT) which showed adrenal hypermetabolic disease with retroperitoneal involvement. He was treated as stage 4 non-Hodgkin's lymphoma (NHL) with two cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy on the same admission; he was discharged home with further follow up for chemotherapy sessions. This case is unique as adrenal involvement in DBCL rarely leads to adrenal insufficiency; his symptoms resolved after receiving adrenal insufficiency treatment which further signifies the importance of its diagnosis and management.