PT  - JOURNAL ARTICLE
AU  - Muhammad Hassan
AU  - Amrendra Kumar Mandal
AU  - Jasdeep Singh Sidhu
AU  - Luz Maria Cardenas
TI  - Gastric diffuse large B-cell lymphoma with bilateral adrenal metastasis
AID  - 10.1136/bcr-2019-229758
DP  - 2019 Jul 01
TA  - BMJ Case Reports
PG  - e229758
VI  - 12
IP  - 7
4099  - http://casereports.bmj.com/content/12/7/e229758.short
4100  - http://casereports.bmj.com/content/12/7/e229758.full
SO  - BMJ Case Reports2019 Jul 01; 12
AB  - Extranodal adrenal involvement in non-Hodgkin’s lymphoma is very rare, estimated to be around less than 0.2%. Most common sites involved are stomach, intestine and testis. It is very rare for adrenal tumours to present as primary adrenal insufficiency, with an incidence of around 1.2% in patients diagnosed with adrenal masses. Diffuse large B cell lymphoma (DLBL) originating from the stomach and metastasizing to bilateral adrenal glands is an extremely uncommon occurrence with only three cases found on review of the literature. We present a case of a 62-year-old African–American man who presented with nausea, vomiting, abdominal pain and hypotension, later being diagnosed as DLBL of the gastric antrum metastasized to bilateral adrenal glands. Initial laboratory workup revealed including hormonal analysis and cosyntropin test revealed adrenal insufficiency. The patient later died during the hospitalisation after developing respiratory failure, severe hypotension refractory to vasopressors and severe metabolic acidosis.