scholarly journals Bilateral Primary Adrenal Lymphoma Presenting with Adrenal Insufficiency

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Jakob Holm ◽  
Leif Breum ◽  
Katrine Stenfeldt ◽  
Mette Friberg Hitz
Keyword(s):  
Adrenal Insufficiency ◽  
Computerized Tomography ◽  
Adrenal Glands ◽  
Healthy Woman ◽  
Adrenal Incidentaloma ◽  
B Cell Lymphoma ◽  
Rapid Progression ◽  
Primary Adrenal Lymphoma ◽  
Adrenal Lymphoma ◽  
Tomography Scan

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.

scholarly journals Bilateral Adrenal Incidentalomas, Uncommon Presentation and Very Rare Pathology

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A119-A119
Author(s):  
Mohammad Khair Ahmad Ibraheem Hamad ◽  
Ahmed Osman Saleh ◽  
Emad Naem
Keyword(s):  
Ct Scan ◽  
Adrenal Insufficiency ◽  
Adrenal Mass ◽  
Adrenal Glands ◽  
Adrenal Incidentaloma ◽  
B Cell Lymphoma ◽  
Primary Adrenal Lymphoma ◽  
Adrenal Lymphoma ◽  
History Of ◽  
Adrenal Masses

Abstract Background: Adrenal incidentaloma is an adrenal mass larger than 1cm accidentally discovered by radiological examination. The incidentalomas should be evaluated for malignancy and functionality. The prevalence of adrenal incidentaloma is 4–10%,1 and around 10–15% of incidentally discovered adrenal masses can be bilateral.2 We present a patient with bilateral adrenal masses due to primary adrenal lymphoma. Clinical Case: 74-year-old gentleman, with past medical history of type-2 Diabetes mellitus, hypertension, presented to our hospital with 2 months history of right-sided flank pain, 20 kg weight loss, loss of appetite and dizziness. Otherwise, no fever, night sweats, bleeding per rectum or urinary symptoms. On physical examination, vital signs were within normal, no remarkable findings other than tenderness over the right flank. Complete blood count and chemistry panel were within normal. Abdominal CT scan was done for evaluation of the abdominal pain which showed two large masses replacing the adrenal glands measure about 10cm in diameter with patchy areas of enhancement. Adrenal insufficiency was suspected based on the symptoms and the CT scan findings. Short syncatin test (high-dose test 250mcg) was done, which showed a cortisol baseline 152nmol/L, 30 minutes 168nmol/L, and 60 minutes 169nmol/L. This was suggestive of adrenal insufficiency, so he was started on hydrocortisone. Screening for pheochromocytoma was done as the patient developed uncontrolled BP readings prior to a scheduled adrenal biopsy. 24-hour urine metanephrines and normetanephrine were negative. CT-guided adrenal mass biopsy showed findings suggestive of large B-cell lymphoma. FDG PET-CT scan showed huge bilateral intense FDG uptake in the adrenal glands with no extra-abdominal manifestations noted. He was started on R-CHOP chemotherapy and after 4cycles, a PET scan showed a significant decrease in the size of previous adrenal masses. Conclusion: Bilateral adrenal incidentaloma should be evaluated the same as unilateral adrenal mass. Although adrenal involvement is common in non-Hodgkin lymphoma, primary adrenal lymphoma is extremely uncommon. References 1.Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, Borasio P, Fava C, Dogliotti L, Scagliotti GV, Angeli A, Terzolo M. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006 Apr;29(4):298–302. doi: 10.1007/BF03344099. PMID: 16699294. 2.Angeli A, Osella G, Alì A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res. 1997;47(4–6):279–83. doi: 10.1159/000185477. PMID: 9167965.

scholarly journals Primary adrenal lymphoma: a case of hiccups

2020 ◽  
Vol 2020 (4-5) ◽  
Author(s):  
Kylan Pathmanathan ◽  
Venkata Kodali ◽  
Abdulrazak Mohamad
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
B Cell Lymphoma ◽  
Primary Adrenal Insufficiency ◽  
Primary Adrenal Lymphoma ◽  
Adrenal Biopsy ◽  
Large B Cell Lymphoma ◽  
Adrenal Lymphoma ◽  
Biochemical Evaluation ◽  
Adrenal Masses

Abstract Approximately 250 cases of primary adrenal lymphoma have been reported. We describe an unusual presentation of this condition. Our patient is a 65-year-old male whom presented to the emergency department with 4 days of severe persistent hiccups. He had lost 26 kg in weight in the preceding 4 months. Computed tomography abdomen revealed large invasive bilateral adrenal masses. Biochemical evaluation confirmed adrenal insufficiency. Hiccups resolved within 24 h of steroid replacement. Adrenal biopsy confirmed a diffuse large B-cell lymphoma. Hypotheses for the aetiology of his hiccups include diaphragmatic irritation and primary adrenal insufficiency. This case is interesting for its rarity involving bilateral adrenal glands, Addison’s disease from the primary adrenal tumour and rapid resolution of hiccups with corticosteroid therapy.

scholarly journals Primary Adrenal Lymphoma: When B Symptoms Appear Hand in Hand with Adrenal Masses

2022 ◽  
Author(s):  
David Lopes Sousa ◽  
Sandra D. Santos ◽  
João Pina Cabral ◽  
Ricardo Velho ◽  
Ana Sofia Teixeira ◽  
...  
Keyword(s):  
B Cell ◽  
Adrenal Glands ◽  
B Cell Lymphoma ◽  
Rare Type ◽  
Primary Adrenal Lymphoma ◽  
Reactive Protein ◽  
Positron Emission ◽  
Adrenal Lymphoma ◽  
Normocytic Normochromic Anaemia ◽  
The Right

Primary adrenal lymphoma (PAL) is a very rare type of non-Hodgkin’s lymphoma (NHL). Herein, we report a case of NHL of both adrenal glands in a 69-year-old man. The patient was admitted because of a 1-month history of B symptoms and symptomatic hypotension. Biochemical analysis showed normocytic normochromic anaemia, hyponatraemia, hyperkalaemia, and elevated lactate dehydrogenase, C-reactive protein and D-dimers. A computed tomography scan revealed bilateral enlargement of the adrenal glands. There was no evidence of endocrine adrenal dysfunction. The mass in the right adrenal gland was biopsied and histopathology identified a diffuse large B-cell lymphoma of the activated B-cell subtype. A positron emission tomography 18F-fluorodeoxyglucose scan showed intensive hypermetabolic lesions involving both adrenal glands, as well as other locations, with higher uptake in the adrenal glands. Taken together, these findings suggested the diagnosis of PAL. The patient responded favourably to debulking therapy and is currently undergoing chemotherapy.

scholarly journals Primary adrenal lymphoma as a cause of adrenal insufficiency, a report of two cases

2020 ◽  
Vol 2020 ◽  
Author(s):  
Kaja Grønning ◽  
Archana Sharma ◽  
Maria Adele Mastroianni ◽  
Bo Daniel Karlsson ◽  
Eystein S Husebye ◽  
...  
Keyword(s):  
B Cell ◽  
Adrenal Insufficiency ◽  
Cell Lymphoma ◽  
Unknown Origin ◽  
B Cell Lymphoma ◽  
List Type ◽  
Primary Adrenal Lymphoma ◽  
Adrenal Lymphoma ◽  
Adrenal Masses ◽  
Learning Points

Summary Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency. More than 90% is of B-cell origin. The condition is bilateral in up to 75% of cases, with adrenal insufficiency in two of three patients. We report two cases of adrenal insufficiency presenting at the age of 70 and 79 years, respectively. Both patients had negative 21-hydroxylase antibodies with bilateral adrenal lesions on CT. Biopsy showed B-cell lymphoma. One of the patients experienced intermittent disease regression on replacement dosage of glucocorticoids. Learning points: Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency. Bilateral adrenal masses of unknown origin or in individuals with suspected extra-adrenal malignancy should be biopsied quickly when pheochromocytoma is excluded biochemically. Steroid treatment before biopsy may affect diagnosis. Adrenal insufficiency with negative 21-hydroxylase antibodies should be evaluated radiologically.

scholarly journals A rare case of primary adrenal lymphoma

Folia Medica ◽  
2021 ◽  
Vol 63 (3) ◽  
pp. 443-447
Author(s):  
Alexey V. Shabunin ◽  
Dmitry N. Grekov ◽  
Ivan N. Lebedinsky ◽  
Andrey I. Evsikov ◽  
Serghei Covantev ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Rare Case ◽  
Cell Lymphoma ◽  
Adrenal Incidentaloma ◽  
B Cell Lymphoma ◽  
Primary Adrenal Lymphoma ◽  
Large B Cell Lymphoma ◽  
Adrenocortical Adenomas ◽  
Abdominal Organs ◽  
Adrenal Lymphoma

Adrenal gland incidentaloma (incidental – sudden, accidental) is a mass of the adrenal gland(s), accidentally detected by an instru-mental examination conducted for other reasons. The frequency of detection of this pathology based on computer tomography of the abdominal organs is 0.5%–2%. In most cases, the mass is represented by adrenocortical adenomas without hormonal secretion. It is an extremely rare case (less than 1% of all cases) when the adrenal incidentaloma is a primary adrenal lymphoma, which accounts for 1% of all non-Hodgkin lymphomas and 3% of all extranodal lymphomas with a few cases reported in the literature. In our article, we present a case of left adrenal incidentaloma of the adrenal gland, which, during further observation and examination, increased in size, which was the reason for performing laparoscopic adrenalectomy. According to the results of the histological examination, the mass turned out to be diffuse large B-cell lymphoma.

Primary Adrenal Lymphoma Associated with Adrenal Insufficiency: A Distinct Clinical Entity

1997 ◽  
Vol 24 (3-4) ◽  
pp. 363-367 ◽  
Author(s):  
Mark Pimentel ◽  
James B. Johnston ◽  
Donald R. Allan ◽  
Howard Greenberg ◽  
Charles N. Bernstein
Keyword(s):  
Adrenal Insufficiency ◽  
Clinical Entity ◽  
Primary Adrenal Lymphoma ◽  
Distinct Clinical Entity ◽  
Adrenal Lymphoma

scholarly journals Silent Intravascular Lymphoma Initially Manifesting as a Unilateral Adrenal Incidentaloma

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Yoshiko Takahashi ◽  
Keiji Iida ◽  
Yasuhisa Hino ◽  
Takeshi Ohara ◽  
Toshifumi Kurahashi ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Adrenal Glands ◽  
Cell Lymphoma ◽  
Adrenal Incidentaloma ◽  
B Cell Lymphoma ◽  
Adrenal Failure ◽  
Intravascular Lymphoma ◽  
Large B Cell Lymphoma ◽  
Bilateral Lesions ◽  
Large B Cell

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of malignant lymphoma. Although the involvement of adrenal glands in IVLBCL is often observed, primary adrenal IVLBCL is rare. Most reported cases of adrenal IVLBCL showed bilateral lesions resulting in rapidly progressive adrenal failure and poor prognosis. Here, we report a case of slowly progressive primary adrenal IVLBCL manifesting initially with unilateral adrenal incidentaloma. This case is a silent IVLBCL and shows that the enlargement of both adrenal glands can be followed.

scholarly journals Histoplasmosis presenting as addisonian crisis in an immunocompetent host

2004 ◽  
Vol 37 (1) ◽  
pp. 60-62 ◽  
Author(s):  
Marcio Fernandes Chedid ◽  
Aljamir Duarte Chedid ◽  
Geraldo Resin Geyer ◽  
Maria Bernadete Fernandes Chedid ◽  
Luiz Carlos Severo
Keyword(s):  
Pulmonary Tuberculosis ◽  
Adrenal Insufficiency ◽  
Computerized Tomography ◽  
Emergency Treatment ◽  
Good Health ◽  
Immunocompetent Host ◽  
Tomography Scan

A 71-year-old man with presumptively treated pulmonary tuberculosis ten years earlier and previous alcoholism presented with adrenal insufficiency. HIV serology was negative. A computerized tomography scan of the abdomen showed enlarged right adrenal. He recovered after emergency treatment with hydrocortisone IV. Right adrenalectomy was performed. Histoplasmosis was diagnosed and the patient was treated with itraconazole, corticosteroid replacement, and discharged with good health.

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