Takiyama Yuri, Nanbu Takashi, Sato Tasuku, Maruyama Fumika, Shukuda Yuki, Takiyama Takao, Sumi Chihiro, Saito Takeshi, Kitsunai Hiroya, Takahashi Shuichiro, Takiyama Yumi, Nomoto Hiroshi
Division of Endocrinology, Metabolism, and Rheumatology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
Division of Hematology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
Front Med (Lausanne). 2025 Sep 3;12:1632514. doi: 10.3389/fmed.2025.1632514. eCollection 2025.
Although lymphoma involving the adrenal gland is uncommon, it is associated with a high incidence of adrenal insufficiency, which may lead to adrenal crisis. The changes in adrenocortical function over the course of lymphoma treatment are not well described. We report three cases with lymphoma with bilateral adrenal enlargement who presented with adrenal insufficiency and had their adrenocortical function monitored during treatment. Case 1 was a 72-year-old man who presented with non-specific symptoms and was diagnosed with lymphoma involving the adrenal glands. Case 2 was a 71-year-old woman who was diagnosed with adrenal lesion of intravascular large B-cell lymphoma. Case 3 was an 84-year-old man diagnosed with primary adrenal lymphoma, presenting rapidly progressing bilateral adrenal tumors. All three were diagnosed with adrenal insufficiency at presentation. Rapid ACTH stimulation test was performed before and after chemotherapy and/or glucocorticoid replacement therapy, and adrenal insufficiency remained in all. Therefore, each required persistent glucocorticoid supplementation despite marked reduction in adrenal lesion. It is important to evaluate adrenocortical function and consider continuing glucocorticoid replacement therapy even after a significant treatment response in adrenal lymphomas.
尽管累及肾上腺的淋巴瘤并不常见，但它与肾上腺功能不全的高发生率相关，这可能导致肾上腺危象。淋巴瘤治疗过程中肾上腺皮质功能的变化尚未得到充分描述。我们报告了3例双侧肾上腺肿大的淋巴瘤患者，他们均出现肾上腺功能不全，并在治疗期间对其肾上腺皮质功能进行了监测。病例1是一名72岁男性，表现为非特异性症状，被诊断为累及肾上腺的淋巴瘤。病例2是一名71岁女性，被诊断为血管内大B细胞淋巴瘤的肾上腺病变。病例3是一名84岁男性，被诊断为原发性肾上腺淋巴瘤，表现为双侧肾上腺肿瘤迅速进展。所有3例患者在就诊时均被诊断为肾上腺功能不全。在化疗和/或糖皮质激素替代治疗前后进行了快速促肾上腺皮质激素刺激试验，所有患者的肾上腺功能不全均持续存在。因此，尽管肾上腺病变明显缩小，但每个患者都需要持续补充糖皮质激素。在肾上腺淋巴瘤中，即使在治疗取得显著反应后，评估肾上腺皮质功能并考虑继续进行糖皮质激素替代治疗也很重要。
