Massive bilateral adrenal mass with adrenal insufficiency: a case report of primary adrenal lymphoma

Primary Adrenal Lymphoma (PAL) is extremely rare and usually occurs in men the 6th-7th decade as bilateral, diffuse large B-cell lymphoma (DLBCL). Here, an 80-year-old patient admitted to urology outpatient clinic with flank pain bilateral adrenal mass detected on ultrasound presented. Positron Emission Tomography-Computed Tomography (PET-CT) was planned for who referred endocrine clinic. The PET-CT scan revealed lobulated-contoured masses containing necrotic areas a size of 7.4×5.5×9.8 cm, 19 Hounsfield Unit (HU), SUVmax value 23.9 right adrenal, 8.4×8.7×10.8 28 HU, 27.3 left adrenal. These were reported be not compatible metastasis suggested tumor origin or adrenocortical carcinoma. In laboratory tests, since Adrenocorticotropic hormone level 291-592 pg/mL (high) Cortisol 7.5-9.5 mcg/dL (low), adrenalectomy performed considering cancer primarily. Diffuse B cell determined result pathology. Postoperative hydrocortisone fludrocortisone treatment initiated immediately. transferred hematology inpatient receive Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone chemotherapy. this case report, we aimed emphasize that differential diagnosis should made well massive masses. Although challenging, clinicians alert diagnosing insufficiency. Since disease's prognosis poor aggressive, histopathological obtained, soon possible.