The adrenal localization of a primary non-Hodgkin lymphoma is rare. We report a case of a 51-year-old man with adrenal insufficiency, cough and elevated eritrosit sedimentation rate. Conventional imaging studies ultrasonography (US) and computed tomography (CT) demonstrated bilateral bulky adrenal masses, and whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed that the masses and peripancreatic lymphadenopathy were the unique manifestations of this disease. The patient was eventually diagnosed with a diffuse large B-cell non-Hodgkin lymphoma after a CT-guided needle adrenal biopsy. The present case indicated that primary adrenal lymphoma should be included in the differential diagnosis of bilateral adrenal masses.