Angiotropic large cell lymphoma is reported in two patients who develo
ped severe metabolic acidosis and unexplained hypotension before death
. In addition to the usual multiorgan involvement of the disease, the
adrenal glands of both patients were symmetrically enlarged. Histologi
cally, the cortical vessels were engorged and filled with neoplastic l
ymphoid cells of B-cell lineage, whereas the parenchymal cells were co
mpressed and atrophic. Angiotrophic large cell lymphoma seems to be a
distinct and unrecognized cause of primary adrenal insufficiency, and
should be included in the differential diagnosis of adrenal hormone de
ficiency. Copyright (C) 1996 by W.B. Saunders Company.