Objective:

To report a case of primary adrenal gland lymphoma as a cause of adrenal insufficiency.

Clinical case:

A 62-year-old female patient who consulted for presenting weight loss, anorexia, malaise and night sweats. On physical examination, diffuse hyperpigmentation of the skin and oral mucosa and evidence of postural hypotension. The abdomen was soft, depressible, with pain on palpation on both flanks and the presence of a palpable tumor in both lumbar regions. Abdominal ultrasound showed tumors in both adrenal glands, which were confirmed by computed tomography that identified large, heterogeneous, and necrotic tumors in both adrenal glands with lobed contours, with no evidence of retroperitoneal lymphadenopathy or visceral involvement. Positron emission tomography showed intense uptake of fluorodeoxyglucose in both adrenal glands. Laboratory tests demonstrated the diagnosis of adrenal insufficiency with a negative stimulation test. Biopsy of the left adrenal gland confirmed the diagnosis of primary lymphoma. Patient started chemotherapy and hydrocortisone replacement treatment.

Conclusion:

Extra-ganglionic lymphomas can appear in any organ. Primary lymphoma of the adrenal gland is a very rare type of extranodal lymphoma. The clinical presentation is nonspecific and may include abdominal pain, weight loss, fever, anemia, nausea, and vomiting. It can often manifest as bilateral adrenal tumors, and adrenal insufficiency is a common complication. It should be considered in the differential diagnosis of bilateral adrenal tumors, especially if the patient has adrenal insufficiency. The prognosis is bad.

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