Adrenal insufficiency caused by primary aggressive non-Hodgkin's lymphoma of bilateral adrenal glands: a report of a case and literature review

A 64-year-old woman was hospitalized because of poor general condition, gas trointestinal upset, unexplained fever, electrolyte imbalances, and an inci dental finding of bilateral huge adrenal masses on computerized tomography (CT) of the abdomen. Non-Hodgkin's lymphoma (NHL) of B-cell origin was prov en by ultrasound-guided aspiration biopsy of the left adrenal gland. Meanwh ile, primary adrenal insufficiency was confirmed by her low serum cortisol level, high ACTH level, and inadequate adrenal response to the rapid ACTH s timulation test. The diagnosis of primary adrenal NHL was supported by deta iled physical examinations, bone marrow examination, and such imaging studi es as CT scan and sonography. She received three courses of chemotherapy wi th cyclophosphamide, vincristine, and prednisolone and there was an initial transient response, but she died of sepsis and progression of NHL three an d a half months later.