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Primary adrenal lymphoma (PAL) is extremely rare, representing less than 1% of Non-Hodgkin's Lymphoma (NHL). We present a case of an elderly man who was evaluated for persistent abdominal pain and adrenal insufficiency. The computed tomogram (CT) of the abdomen showed large bilateral adrenal mass. There were also multiple small lung nodules. The histopathology of adrenal gland showed features consistent with diffuse large B-cell Non-Hodgkin lymphoma. He received two cycles of rituximab, cyclophosphamide, doxorubicine, vincristine and prednisolone (R-mini-CHOP) and five cycles of rituximab, methotrexate, procarbazine, and vincristine (R-MPV) after further imaging showed evidence of brain metastasis. He responded well with the current treatment at six months follow up.