title: Diffuse large B-cell lymphoma of the adrenal gland: a rare cause of primary adrenal insufficiency.
abstract: Although it is a rare entity, primary lymphoma of the adrenal gland should be considered in the differential diagnosis of bilateral nodular adrenal lesions, particularly when there is evidence of associated adrenal insufficiency. We describe the case of an 83-year-old woman admitted to the emergency department due to a month's history of asthenia, weight loss, anorexia and nausea. Abdominopelvic CT showed bilateral nodular lesions of adrenal glands and a stimulation test with tetracosactide was compatible with primary adrenal insufficiency. CT-guided biopsy of the left adrenal gland was performed, and histopathological results were consistent with diffuse large B-cell lymphoma. Positron emission tomography (18)F-fluorodeoxyglucose detected two intensely hypermetabolic lesions limited to both adrenal glands. Replacement therapy with hydrocortisone 15 mg/day and fludrocortisone 0.1 mg/day was promptly started and chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone was initiated after haematology-oncology consultation.
authors.affiliation: Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Adriana
authors.initials: A
authors.lastname: de Sousa Lages
authors.affiliation: Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Bastos
authors.affiliation: Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Oliveira
authors.affiliation: Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carrilho
mesh_terms: D000224:Addison Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000311:Adrenal Glands / Q000473:pathology*; D000309:Adrenal Insufficiency; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D049268:Positron-Emission Tomography / Q000379:methods
chemical_list: D005438:Fludrocortisone