cosyntropin and Lymphoma

We report here a woman in her 70s presenting with adrenal insufficiency secondary to a primary adrenal lymphoma. The patient had a previous history of aphthous ulcers on dexamethasone and was referred to endocrinology with symptoms of fatigue and orthostasis. Subsequent Cosyntropin stimulation showed primary adrenal insufficiency and adrenal CT demonstrated large infiltrative masses. Adrenal biopsy confirmed the diagnosis of primary adrenal lymphoma of the B-cell type. This case demonstrates the importance of including lymphoma in the differential diagnosis of adrenal insufficiency, particularly in the elderly population and in the setting of negative 21-hydroxlyase antibody results.

Topics: Addison Disease; Adrenal Gland Neoplasms; Adrenal Insufficiency; Aged; Cosyntropin; Dexamethasone; Female; Humans; Lymphoma; Lymphoma, B-Cell; Tomography, X-Ray Computed

Ketoconazole, a potent antifungal agent, inhibits adrenal steroidogenesis in normal subjects during short term treatment. Since this drug is used in the long term prophylaxis of fungal infections in patients with haematological malignancies, we have investigated whether such patients have evidence of adrenocortical suppression. Six patients on long term prophylaxis with ketoconazole were given tetracosactrin stimulation tests. All patients had high basal cortisol concentrations, which increased further after administration of 25 IU of tetracosactrin. It is concluded that leukaemic patients receiving long term ketoconazole treatment do not have adrenocortical suppression. They may, in fact, have hyperstimulated adrenocortical function due to stress and hypovolaemia.

Topics: Adult; Aged; Cosyntropin; Humans; Hydrocortisone; Ketoconazole; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lymphoma; Middle Aged

A 81-year-old man presented with bilateral adrenal masses found pathologically to be a large cell, non-follicular center, non-Hodgkin's lymphoma. His clinical course was remarkable for the lack of macroscopic extra-adrenal tumor and for adrenal insufficiency in response to stress and cosyntropin stimulation. This is believed to be the first reported case of a non-Hodgkin's lymphoma limited to the adrenal glands with associated adrenal insufficiency.

Topics: Adrenal Gland Neoplasms; Adrenal Insufficiency; Aged; Cosyntropin; Hormones; Humans; Lymphoma; Male; Tomography, X-Ray Computed

Topics: Adrenal Glands; Antineoplastic Agents; Cosyntropin; Humans; Hypothalamus; Lymphoma; Pituitary Gland; Pituitary-Adrenal System; Prednisolone