A case of adrenal insufficiency caused by bilateral adrenal malignant lymphoma in a hemodialysis patient

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  • 両側性副腎原発悪性リンパ腫による副腎不全を呈した血液透析患者の１例
  • 症例報告 両側性副腎原発悪性リンパ腫による副腎不全を呈した血液透析患者の1例
  • ショウレイ ホウコク リョウガワセイ フクジン ゲンパツ アクセイ リンパシュ ニ ヨル フクジン フゼン オ テイシタ ケツエキ トウセキ カンジャ ノ 1レイ

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Abstract

We report here a rare case of bilateral primary adrenal malignant lymphoma with adrenal insufficiency in a patient receiving regular hemodialysis. A 74-year-old man was referred to our hospital from a local clinic because of anorexia and hypoglycemia. Abdominal CT scan demonstrated bilateral adrenal tumors, and the ACTH value was beyond the normal range (328 pg/mL). He was diagnosed as having adrenal insufficiency. After we administered hydrocortisone 20 mg/day, his general condition improved dramatically, and dopamine and noradrenaline levels were improved (96 pg/mL→16 pg/mL, 1,117 pg/mL→216 pg/mL, respectively) simultaneously. A right upper jaw tumor biopsy showed diffuse large B-cell lymphoma, and gallium scintigraphy demonstrated strong uptake in the right upper jaw, mediastinum and bilateral adrenal glands, suggesting that adrenal insufficiency was caused by bilateral adrenal malignant lymphoma.<br>To our knowledge, primary adrenal malignant lymphoma or adrenal insufficiency in a hemodialysis patient has not been reported previously. In addition to the case report, we discuss catecholamine metabolic disorder in adrenal insufficiency.

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