Zaman Shamaila, Boharoon Hessa, Khalid Neelam, Marks Sasha, Alsafi Ali, Flora Rashpal, Hill Neil, Hatfield Emma, Meeran Karim
Imperial Centre for Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London, United Kingdom.
Haematology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
AACE Clin Case Rep. 2020 Dec 28;7(2):109-112. doi: 10.1016/j.aace.2020.11.022. eCollection 2021 Mar-Apr.
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.
We 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 [normal, <1180]; metanephrine, <100 pmol/L [<510]; 3-methoxytyramine, <100 pmol/L [<180]); 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 <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.
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.
地塞米松是淋巴瘤的一种已知治疗药物，但其疗效的强度和迅速性尚未得到认可。我们报告一例双侧肾上腺淋巴瘤患者，单次服用地塞米松后肿瘤大小显著缩小。
我们介绍了该患者的临床病程及检查情况，包括促肾上腺皮质激素、皮质醇、短程促肾上腺皮质激素试验、计算机断层扫描（CT）及肾上腺活检结果。
一名52岁男性摔倒后，CT检查偶然发现双侧肾上腺肿块（左侧6 cm，右侧5 cm）。他的肾上腺功能检查结果包括血浆甲氧基肾上腺素（去甲氧基肾上腺素，830 pmol/L[正常，<1180]；甲氧基肾上腺素，<100 pmol/L[<510]；3-甲氧基酪胺，<100 pmol/L[<180]）；醛固酮，270 pmol/L（90 - 700）；随机皮质醇，230 nmol/L（160 - 550）。服用1 mg地塞米松进行过夜地塞米松抑制试验，结果显示皮质醇<28 nmol/L（0 - 50）。8天后复查CT扫描显示，左侧肾上腺肿块为4.5 cm，右侧为3.5 cm。3个月后他进行了随访CT扫描，显示肾上腺病变左侧为8 cm，右侧为9 cm。随后他出现疲劳和头晕症状。晨起皮质醇为201 nmol/L（160 - 550），促肾上腺皮质激素为216 ng/L（10 - 30），提示原发性肾上腺功能不全。开始进行盐皮质激素和糖皮质激素替代治疗。肾上腺活检显示B细胞异常增大，符合弥漫性大B细胞淋巴瘤的诊断。
即使作为诊断试验一部分给予单次低剂量地塞米松后肾上腺病变缩小，也应考虑淋巴瘤的诊断。
