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Primary adrenal lymphoma with initial presentation concerning for bilateral adrenal pheochromocytomas
  1. Flavian Grace Joseph,
  2. Sheila Cook,
  3. Durgesh Gowda
  1. Department of Endocrinology, Toowoomba Health Service, Toowoomba, Queensland, Australia
  1. Correspondence to Dr Flavian Grace Joseph, eusebiojo{at}


Primary adrenal non-Hodgkin’s lymphoma is rarely encountered. Clinical presentation is non-specific with fatigue, abdominal pain and B-symptoms being more commonly reported. We report a case of primary bilateral adrenal lymphoma who initially presented with clinical features suspicious for pheochromocytoma. The patient was recently diagnosed with hypertension and had a family history of early ischaemic heart disease. Plasma free metanephrines were also elevated. Pheochromocytoma was deemed unlikely following multiple investigations and the diagnosis of lymphoma was made following adrenal biopsy. Partial response was noted on positron emission tomography CT scan following four cycles of chemotherapy but failed to remit after six cycles of chemotherapy. Subsequently, he received 20 fractions of radiation to his adrenal glands and is now awaiting further imaging. The presentation of primary adrenal lymphoma can be variable and given that the diagnosis is obtained through tissue sampling, pheochromocytoma should be excluded due to risk of a potentially fatal adrenergic crisis.

  • endocrine system
  • adrenal disorders
  • haematology (incl blood transfusion)
  • medical education
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  • Contributors FGJ recruited patient for case report, data collection, literature review and write up of case report. SC and DG have contributed by reviewing the available literature.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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