Primary adrenal insufficiency manifesting as malignant lymphoma

Primary adrenal insufficiency associated with a hematologic malignant neoplasm is a rare entity. Most malignant neoplasms with metastases to the adrenal gland are secondary to solid carcinomas of the lung and breast. A 55-year-old man was seen with clinical and biochemical evidence of primary adrenal insufficiency as the initial manifestation of his malignant lymphoma. At autopsy the architecture of both adrenal glands was completely effaced by malignant plasmacytoid cells. This case emphasizes that infiltrative lymphoma of the abdomen is a rare cause of primary adrenal insufficiency and may be the initial manifestation. Furthermore, it should be included in the differential diagnosis.