A case of primary adrenal diffuse large B cell lymphoma presenting with severe hyponatremia

CEN Case Reports
Mikiko ItayaAkira Hishida

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 symptom...Continue Reading

References

Apr 22, 1999·Postgraduate Medical Journal·G Gill, G Leese
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May 27, 2004·Leukemia & Lymphoma·Devinder SinghN Tandon
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Aug 31, 2012·Diagnostic Pathology·Tomohide TsukaharaTadashi Hasegawa
Jun 19, 2013·Annals of Hematology·Armin Rashidi, Stephen I Fisher

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