Severe hypercalcemia as the presenting manifestation of bilateral primary adrenal lymphoma

Primary adrenal lymphoma (PAL) is a rare tumor with fewer than 300 cases reported to date. In the absence of characteristic imaging features and diagnostic serum markers, a biopsy remains the definitive way to diagnose PAL. Although rituximab-based chemotherapeutic regimens have led to improved outcomes, late presentation, undetected, and untreated adrenal insufficiency result in a dismal prognosis. Although it is well known that hypercalcemia in malignancy carries a grave outcome, well documented cases of hypercalcemia association with PAL is very rarely described in the literature. Here, we describe a case of PAL that predominantly presented with gastrointestinal manifestations of hypercalcemia.