Objective: Dexamethasone is a known treatment for lymphoma, but it’s potency and rapidity of its effect has not been recognised. Our objective is to present a case of bilateral adrenal lymphoma, which significantly reduced in size after a single dose of dexamethasone.

Methods: Clinical course and investigations including Adrenocorticotropic hormone (ACTH), cortisol, short synacthen test, computed tomography (CT) and adrenal biopsy are presented.

Results: A 52-year-old man had a fall and was incidentally found to have bilateral adrenal masses (6 cm on left and 5 cm on right) on CT. His adrenal function tests included plasma metanephrines (normetanephrine 830 pmol/L (0-1180); metanephrine <100 pmol/L (0-510); 3-methoxytyramine <100 pmol/L (0-180), aldosterone 270 pmol/L( 90-700) and random cortisol 230 nmol/L (160-550). Overnight dexamethasone suppression test (ONDST), with 1 mg of dexamethasone, showed cortisol of <28 nmol/L (0-50).. A repeat CT, eight days following ONDST, showed adrenal masses of 4.5 cm and 3.5 cm on left and right respectively. He had a follow-up CT three months later, which 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 ACTH of 216 ng/L (10-30) indicated primary adrenal insufficiency. Mineralocorticoid and glucocorticoid replacement was commenced. Adrenal biopsy showed abnormal enlarged B-cells consistent with a diagnosis of diffuse large B-cell lymphoma.


Conclusion: 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.