The Vanishing Adrenal Glands: A Transient Regression of Adre
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Dexamethasone is a known treatment for lymphoma, but the potency and rapidity of its effect have not been recognized. We present a case of bilateral adrenal lymphoma that significantly reduced in size after a single dose of dexamethasone.

Authors present the clinical course and investigations, including adrenocorticotropic hormone, cortisol, short synacthen test, computed tomography (CT), and adrenal biopsy results.

-- A 52-year-old man had a fall and was incidentally found to have bilateral adrenal masses (left, 6 cm; right, 5 cm) on CT.

-- His adrenal function tests included plasma metanephrines (normetanephrine, 830 pmol/L; metanephrine, less than 100 pmol/L; 3-methoxytyramine, less than 100 pmol/L); aldosterone, 270 pmol/L( 90-700); and random cortisol, 230 nmol/L (160-550).

-- An overnight dexamethasone suppression test with 1 mg of dexamethasone showed cortisol of less than 28 nmol/L (0-50).

-- A repeat CT scan 8 days thereafter showed adrenal masses of 4.5 and 3.5 cm on the left and right, respectively.

-- He had a follow-up CT scan 3 months later that showed adrenal lesions measuring 8 cm (left) and 9 cm (right).

-- He subsequently presented with fatigue and dizziness. Morning cortisol of 201 nmol/L (160-550) with adrenocorticotropic hormone of 216 ng/L (10-30) indicated primary adrenal insufficiency.

-- Mineralocorticoid and glucocorticoid replacement therapy commenced.

-- An adrenal biopsy showed abnormal enlarged B cells, consistent with a diagnosis of diffuse large B-cell lymphoma.

Conclusively, a diagnosis of lymphoma should be considered when adrenal lesions shrink following even a single low dose of dexamethasone administered as a part of a diagnostic test.