Primary Adrenal Lymphoma Presenting as Addison's Disease

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.

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.

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.

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