Key result
In a 57-year-old man with primary bilateral adrenal non-Hodgkin's lymphoma, treatment with CHOP chemotherapy and bilateral adrenalectomy was followed by death at 7 months due to disease progression.
Case Report (n=1)
Primary bilateral adrenal non-Hodgkin's lymphoma is a rare cause of adrenal insufficiency that is typically treated with chemotherapy and surgery, though prognosis remains poor.
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May prompt lymphoma consideration in bilateral adrenal masses with insufficiency; leaves open optimal management strategies.
AIMS AND BACKGROUND: Primary bilateral adrenal non-Hodgkin's lymphoma is an extremely rare entity. Only 44 cases have been reported in the literature. The most common presenting symptoms are abdominal pain, fever, asthenia, constipation, weight loss or typical symptoms of adrenal insufficiency, hypertension, darkening of skin, orthostatic hypotension or an addisonian crisis. METHODS: The case is presented of a 57-year-old man suffering from primary bilateral adrenal lymphoma with symptoms of adrenal insufficiency syndrome associated with bilateral, stabbing lumbar pain and a palpable mass on the left side. Laboratory tests revealed a considerable increase in lactate dehydrogenase levels, adrenal insufficiency, and high corticotropin levels. RESULTS: Abdominal CT scan showed two large adrenal masses. A CT-guided fine needle aspiration biopsy revealed a large B-cell non-Hodgkin's lymphoma. Combination chemotherapy according to the CHOP protocol with cyclophosphamide, doxorubicin, vincristine and prednisolone was initiated, which caused a slight reduction in size of the two adrenal masses. The patient underwent a bilateral adrenalectomy with almost complete excision of the tumors. Replacement therapy with cortisone acetate was initiated postoperatively. Adjuvant combination chemotherapy according to the CHOP protocol was started but renal failure gradually emerged and the treatment could not be completed. The patient died seven months after surgery due to acute bronchial pneumonia and progression of disease. CONCLUSIONS: Primary bilateral adrenal non-Hodgkin's lymphoma mainly affects adult men. Diagnosis is based on histological examination. Whether associated or not with radiotherapy, chemotherapy is the most recommended treatment. Surgery, where possible, seems to lead to an increase in survival rates, but it is not possible to draw any definite conclusions on its effectiveness as yet.
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Dobrinja et al. (2007) conducted a case report in Primary bilateral adrenal non-Hodgkin's lymphoma (n=1). CHOP chemotherapy and bilateral adrenalectomy was evaluated on Clinical course and survival. In a 57-year-old man with primary bilateral adrenal non-Hodgkin's lymphoma, treatment with CHOP chemotherapy and bilateral adrenalectomy was followed by death at 7 months due to disease progression.
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