Abstract
We herein report a case of primary adrenal lymphoma with severe hyponatremia. The patient was admitted for an evaluation of severe hyponatremia and an enlarged bilateral adrenal mass, which were found in a previous examination for causes of general fatigue and anorexia. Laboratory data, including the serum levels of sodium (115 mEq/L), osmolality (239 mOsm/kgH2O), ADH (5.8 pg/mL), cortisol (11.6 μg/dL), free T3 (2.42 pg/mL), urinary Na (117 mEq/L) and urine osmolality (490 mOsm/kgH2O), fulfilled the diagnostic criteria for the syndrome of inappropriate secretion of ADH (SIADH). An abdominal computed tomography scan revealed a large bilateral adrenal mass. A biopsy of the enlarged left adrenal mass revealed diffuse large B cell lymphoma, which was negative for ADH protein. Hydrocortisone treatment normalized the patient’s body temperature and serum sodium concentration. In this case, hyponatremia developed when both adrenal glands were involved and was normalized with hydrocortisone. These findings suggest that adrenal insufficiency was the cause of hyponatremia, although the basal serum cortisol was normal. The current case suggests that the administration of hydrocortisone is recommended if suspicious clinical signs or symptoms are found in severe hyponatremia, even if hyponatremia is associated with a normal serum cortisol level and fulfills the diagnostic criteria for SIADH.
Similar content being viewed by others
References
Rashidi A, Fisher SI. Primary adrenal lymphoma: a systematic review. Ann Hematol. 2013;92:1583–93.
Singh D, Kumar L, Sharma A, Vijayaraghavan M, Thulkar S, Tandon N. Adrenal involvement in non-Hodgkin’s lymphoma: four cases and review of literature. Leuk Lymphoma. 2004;45:789–94.
Gamelin E, Beldent V, Rousselet MC, Rieux D, Rohmer V, Ifrah N, Boasson M, Bigorgne JC. Non-Hodgkin’s lymphoma presenting with primary adrenal insufficiency. A disease with an underestimated frequency? Cancer. 1992;69:2333–6.
Tsukahara T, Takasawa A, Murata M, Okumura K, Nakayama M, Sato N, Hasegawa T. NK/T-cell lymphoma of bilateral adrenal glands in a patient with pyothorax. Diagn Pathol. 2012;29(7):114. doi:10.1186/1746-1596-7-114.
Holm J, Breum L, Stenfeldt K, Friberg Hitz M. Bilateral primary adrenal lymphoma presenting with adrenal insufficiency. Case Rep Endocrinol. 2012;2012:638298. doi:10.1155/2012/638298.
Kobayashi K, Yokote T, Akioka T, Takubo T, Tsuji M, Hanafusa T. Inappropriate antidiuretic hormone production in diffuse large B-cell lymphoma. Br J Haematol. 2008;143:2.
Hirata Y, Yokote T, Nishiwaki U, Tsuji M, Hanafusa T. Syndrome of inappropriate antidiuretic hormone secretion associated with primary cutaneous anaplastic large cell lymphoma. Br J Haematol. 2012;157:412.
Gill G, Leese G. Hyponatraemia: biochemical and clinical perspectives. Postgrad Med J. 1998;74:516–23.
Wiebke A. Disorders of the adrenal cortex. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine. 18th ed. New York: McGraw-Hill; 2012. p. 2940–61.
Smith JC, Siddique H, Corrall RJ. Misinterpretation of serum cortisol in a patient with hyponatraemia. BMJ. 2004;328:215–6.
Saito T. SIADH and other hyponatremic disorders: diagnosis and therapeutic problems. Jpn J Nephrol. 1996;38:429–34.
Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga G, Bokhari F, Vogeser M, American College of Critical Care Medicine. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36:1937–49.
Diederich S, Franzen NF, Bähr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol. 2003;148:609–17.
Shibata T, Oeda T, Saito Y. Severe hyponatremia caused by hypothalamic adrenal insufficiency. Intern Med. 1999;38:426–32.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors have declared no competing interest.
About this article
Cite this article
Itaya, M., Nagata, S., Ogino, S. et al. A case of primary adrenal diffuse large B cell lymphoma presenting with severe hyponatremia. CEN Case Rep 5, 91–94 (2016). https://doi.org/10.1007/s13730-015-0200-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13730-015-0200-3