Primary Adrenal Lymphoma

An 83 year old man with a history of coronary artery disease, hypertension, and hyperlipidemia presented with fatigue, weight loss, and hypotension. Laboratory tests revealed hyponatremia, hyperkalemia, and adrenal insufficiency, confirmed by inadequate cortisol response to cosyntropin stimulation. Imaging showed bilateral adrenal enlargement (>9 cm each), and biopsy confirmed high-grade B-cell lymphoma. Primary adrenal lymphoma is rare and often associated with adrenal insufficiency. Treatment with hydrocortisone, fludrocortisone, and chemotherapy led to clinical improvement.

An 83 year old man with a history of coronary artery disease, hypertension, and hyperlipidemia presented with fatigue, weight loss, and hypotension. Laboratory tests revealed hyponatremia, hyperkalemia, and adrenal insufficiency, confirmed by inadequate cortisol response to cosyntropin stimulation. Imaging showed bilateral adrenal enlargement (>9 cm each), and biopsy confirmed high-grade B-cell lymphoma. Primary adrenal lymphoma is rare and often associated with adrenal insufficiency. Treatment with hydrocortisone, fludrocortisone, and chemotherapy led to clinical improvement.