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Clinical Medicine & Research
Volume 6, Number 1 : 29
doi:10.3121/cmr.2007.754a
© 2008 Marshfield Clinic
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The Aperture

Diagnosis–Addison’s Disease Secondary to Tuberculosis of the Adrenal Glands

Mrinal M. Patnaik, MD* and Alaka K. Deshpande, MD

Mrinal M Patnaik, MD, Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55414 USA, Email: mrinal.patnaik{at}gmail.com
Alaka Deshpande, MD, Department of Internal Medicine, Grant Medical College and Sir JJ Hospital, Mumbai, India

* Corresponding Author

Received: February 7, 2007.

Accepted: March 23, 2007.

Key Words: Ascites • Cortisol • Cystic adrenal hyperplasia • Computed tomography • Tuberculosis

A diagnosis of Addison’s disease secondary to tuberculosis of the adrenal glands was made for the case presented in the December 2007 Aperture.1 The computed tomography (CT) scan in figure 1Go demonstrates the presence of free fluid in the patient’s abdomen and bilateral cystic adrenal hyperplasia. The patient was started on four-drug anti-tuberculosis therapy (isoniazid, rifampin, pyrazinamide and ethambutol) along with hydrocortisone supplementation. Fludrocortisone was added to augment his blood pressure response. Over the next few weeks he showed a marked improvement in constitutional symptoms. The free fluid in the abdomen resolved, and he is currently on his eighth month of anti-tuberculosis drug therapy, along with continued steroid supplementation.


Figure 1
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  		Figure 1. CT scan indicating bilateral cystic adrenal hyperplasia and free fluid in the abdomen (arrow points to the very fine, hypodense region between the liver margin and the anterior abdominal wall).

 
In 1855, Thomas Addison described autopsy findings of six patients with adrenal tuberculosis, which continues to be one of the most common causes of adrenal insufficiency in the developing world. In a recent study Guo et al,2 compared the contrast enhanced CT scan features of the adrenal glands in 42 patients with adrenal tuberculosis. Of these patients, 91% (38) had bilaterally enlarged adrenals and 51% (21) had enlarged glands with preservation of the contours.2 Other important, although less common causes of adrenal insufficiency that need to be considered in the clinical differential diagnosis include histoplasmosis, blastocmycosis, adrenal metastases, primary adrenal tumors and opportunistic infections related to HIV/AIDS.3

References:

  1. Patnaik MM, Deshpande, AK. Cystic adrenal hyperplasia–diagnosis? Clin Med Res 2007;5:227.[Free Full Text]
  2. Guo YK, Yang ZG, Li Y, Ma ES, Deng YP, Min PQ, Yin LL, Hu J, Zhang XC, Chen TW. Addison’s disease due to adrenal tuberculosis: Contrast-enhanced CT features and clinical duration correlation. Eur J Radiol 2006;62:126–131.[CrossRef][Web of Science][Medline]
  3. Oelkers W. Adrenal insufficiency. N Engl J Med 1996;335:1206–1212.[Free Full Text]



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M. E BERRY
Adrenal Gland Disorders
Radiol. Technol., September 1, 2009; 81(1): 57 - 73.
[Abstract] [Full Text] [PDF]

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