Weight loss, inflammation and bilateral adrenal masses – it's not always tuberculosis

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 1-16-Adrenal Insufficiency
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-7
Rebecca Locher*1, Stefan Bilz2, Wibke Billmann3, Markus Jörger4, Sergio Cogliatti4 and Michael Braendle5
1University Hospital of Zurich, Zürich, Switzerland, 2Cantonal Hospital Saint gallen, St. Gallen, Switzerland, 3Cantonal Hospital of St. Gallen, St. Gallen, Switzerland, 4Cantonal hospital of St. Gallen, St. Gallen, Switzerland, 5Kantonsspital St Gallen, St Gallen, Switzerland
Background

The differential diagnosis of bilateral adrenal masses includes macronodular hyperplasia, metastatic disease, bacterial and fungal infections, congenital adrenal hyperplasia, rarely bilateral adenomas or pheochromocytomas. Primary adrenal lymphoma is an extremely rare clinical entity with cases of both uni- and bilateral involvement reported.

Case report

A 56-year-old black woman was referred for the workup of recent weight loss, aggravated headaches and elevated inflammatory markers. A thoracoabdominal CT scan revealed bilateral expansive tumors of the adrenal glands and an enlarged spleen. Her African ancestry, history of heavy smoking and positive mantoux tuberculin skin test pointed to the diagnosis tuberculosis or bronchial carcinoma with adrenal metastasis as the main differential diagnosis. After bronchial lavage and fine needle puncture of a hilar lymph node failed to show malignant cells or acid-proof rods, the CT guided biopsy of the adrenal mass led to the diagnosis of a large B-cell Non Hodgkin lymphoma. Hydrocortisone substitution was begun for suspected primary adrenal insufficiency. After 2 cycles of chemotherapy with R-CHOP, the bilateral adrenal tumors were clearly regressing in size.

Conclusion

Primary adrenal lymphoma is extremely rare, but should be considered in the work-up of adrenal masses. Pathologically large diffuse B-cell lymphomas are the most frequently reported phenotype and bilateral adrenal involvement and adrenal insufficiency are common. Chemotherapy is the treatment modality of choice, but the prognosis may be poorer when compared to patients with primary nodal involvement.

Nothing to Disclose: RL, SB, WB, MJ, SC, MB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm