Primary Adrenal Lymphoma Presenting as Addison's Disease.

PRESENTATION: Primary adrenal lymphoma is an unusual but life-threatening cause of adrenal insufficiency. A man in his 50s with type 2 diabetes presented with malaise, gastrointestinal symptoms, dyspnoea and significant unintentional weight loss.

DIAGNOSIS: Imaging revealed large bilateral adrenal masses with pulmonary nodules, initially suggesting metastatic disease. He later developed hypotension and electrolyte abnormalities and a short synacthen test supported adrenal insufficiency. Adrenal biopsy confirmed diffuse large B-cell lymphoma with widespread disease on PET imaging.

TREATMENT: Glucocorticoid and mineralocorticoid replacement led to rapid clinical improvement, followed by systemic chemotherapy. He completed six cycles with good tolerance, achieving a marked clinical and radiological response, but remained on long-term steroid replacement.

DISCUSSION: This case highlights the importance of early adrenal assessment in patients with bilateral adrenal masses to prevent adrenal crisis and facilitate timely multidisciplinary management.