International Journal of Clinical Case Reports 2017, Vol.7, No.11, 45-48
45
Research Report Open Access
Pseudotumoral Adrenal Tuberculosis
Said Azzoug
1
, Brahim Terki
2
, Farida Chentli
2
, Djamila Meskine
1
1 Endocrine diseases department Bologhine Hospital Algiers, Algeria
2 Endocrine diseases department Bab El Oued Hospital Algiers, Algeria
Corresponding author email
International Journal of Clinical Case Reports 2017, Vol.7, No.11 doi
Received: 24 Jul., 2017
Accepted: 30 Aug., 2017
Published: 08 Sep., 2017
Copyright © 2017
Azzoug et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Azzoug S., Terki B., Chentli F., and Meskine D., 2017, Pseudotumoral adrenal tuberculosis, International Journal of Clinical Case Reports, 7(11): 45-48
(doi
Abstract
Tuberculosis is rare nowadays, however, it should be kept in mind in the differential diagnosis of adrenal insufficiency
notably in developing countries or in immunocompromised patients. We report here a case of adrenal insufficiency secondary to
tuberculosis with bilateral adrenal masses. A 45 years old man was admitted to our department for investigation of a primary adrenal
failure. His past medical history was significant for pleural tuberculosis eighteen years ago. He reported several months’ history of
generalized weakness and unintentional weight loss. On physical examination, he presented diffuse hyperpigmentation. On hormonal
assessment, there was low basal cortisol level and a high level of corticotrophin. Computed tomography scan showed bilaterally
enlarged adrenal glands. The tuberculin skin test was positive. With the background of tuberculosis, adrenal insufficiency diagnosed
by laboratory test and positive tuberculin skin test, bilateral enlargement of adrenal glands was considered most consistent with
tuberculosis. Tuberculosis remains a classic cause of adrenal insufficiency with adrenal masses. Therefore, it needs to be considered
in the differential diagnosis of adrenal insufficiency or bilateral adrenal masses.
Keywords
Tuberculosis; Adrenal insufficiency; Bilateral adrenal masses
Background
When Thomas Addison described autopsy findings of six patients with adrenal tuberculosis, in 1855, adrenal
tuberculosis was the main cause of adrenal insufficiency. Although it is less frequent nowadays, tuberculosis
remains one of the causes of adrenal insufficiency especially in the developing world. Therefore, it should be kept
in mind when evaluating a patient with adrenal insufficiency.
1 Observation
A 45 years old man was admitted to our department for investigation of a primary adrenal failure with bilateral
adrenal masses. He worked as a secretary. His past medical history was significant for pleural tuberculosis
eighteen years ago. His father had also pleural tuberculosis. The patient reported several months’ history of
generalized weakness and unintentional weight loss.
On physical examination, he presented diffuse hyperpigmentation which predominated on exposed regions. His
blood pressure was at 110/60 mm Hg and his pulse at 74/minute. The remaining clinical exam was unremarkable,
notably, there were not pulmonary signs.
On hormonal assessment, there was low basal cortisol level at 39.4 nmol/l (N: 154-638) and a high level of
corticotrophin (ACTH) at 602 pg/ml (N: 7.2-63.3). The remaining laboratory findings revealed mild hypochromic
microcytic anemia.
Computed tomography (CT) scan showed bilaterally enlarged adrenal glands. The left adrenal mass measured
42x20x16.7 mm with calcifications and low enhancement on contrast enhanced CT scan (Figure 1). The right
adrenal gland was also enlarged with moderate enhancement on contrast enhanced CT scan (Figure 2).
Tumor markers and endoscopic studies (oesophagogastroduodenoscopy and colonoscopy) were normal. CT scan
of the chest revealed pleural nodules and pulmonary infiltrate regarding previous tuberculosis. Serology for
