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.
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.