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Although lymphoma may involve the adrenal glands as part of a generalised disease process, primary adrenal lymphoma is a rare entity. We present the case of a man in his late 60s who was admitted via the emergency department with clinical features consistent with adrenal failure. Initial investigations demonstrated anaemia, hypercalcaemia and adrenal insufficiency. Further biochemical work-up showed no evidence of an autoimmune or congenital aetiology of adrenal failure, and diagnostic imaging revealed bilateral adrenal enlargement. Adrenal biopsy revealed a diagnosis of diffuse large B-cell lymphoma. The patient achieved complete metabolic remission following first-line immunochemotherapy, though adrenal function remained compromised. We review the published literature and discuss diagnostic challenges in patients presenting with adrenal insufficiency of unclear aetiology.