Primary Adrenal Insufficiency due to Tuberculosis Infection Pitfalls in Diagnosis and Management

Authors

  • Ira Laurentika Division of Endocrinology, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangun Kusumo General Hospital, Jakarta, Indonesia Author
  • Em Yunir Division of Endocrinology, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangun Kusumo General Hospital, Jakarta, Indonesia Author
  • Tri Juli Edi Tarigan Division of Endocrinology, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangun Kusumo General Hospital, Jakarta, Indonesia Author
  • Agnes Stephanie Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Cipto Mangun Kusumo General Hospital, Jakarta, Indonesia Author
  • Robert Shinto Division of Tropical Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Cipto Mangun Kusumo General Hospital, Jakarta, Indonesia Author
  • Taufik Agung Department of Radiology, Faculty of Medicine Universitas Indonesia/Cipto Mangun Kusumo General Hospital, Jakarta, Indonesia Author

DOI:

https://doi.org/10.66266/inajemd.v1i1.6

Keywords:

Addison disease primary, adrenal insufficiency, hypocortisolism, adrenal, tuberculosis

Abstract

Primary adrenal insufficiency (PAI) is a chronic condition in which both adrenal glands are not able to produce steroid hormones. In this article we reported a-20-year-old male with history of soft tissue tumor in thoracal
region and general hyperpigmentation of skin and mucous. Laboratory findings showed hypocortisolism and adrenal computed tomography (CT) scan showed bilateral enlargement of adrenal with multiple necrotic nodular lesion and calcification, suggesting adrenal metastasis or tuberculosis infection. The interferon gamma release assay (IGRA) and histopathology review of the specimen from soft tissue tumor in thoracal region showed confirmed the diagnosis of adrenal tuberculosis. Antituberculosis drugs were started, and hydrocortisone dose were frequently adjusted. Five months after therapy the patient is clinically improved with a minimal dose of steroid.

Downloads

Download data is not yet available.

References

1.

Van Haren Noman S, Visser H, Muller AF, Limonard GJM. Addison's disease caused by tubercolosis: diagnostic and therapeutic difficulties. Eur J of Case Rep in Intern Med 5.8 (2018).

2. Upadhyay J, Sudhindra P, Abraham G, Trivedi N. Tuberculosis of the adrenal gland: a case report and review of the literature of infections of the adrenal gland. Int J Endocrinol. 2014; 2014:876037.

3. Gupta S, Ansari MAM, Gupta AK, Chaudhary P, Bansal LK. Current approach for diagnosis and treatment of adrenal tuberculosis-our experience and review of literature. Surg J (N Y). 2022;8(1):e92-e97.

4. Vinnard C, Blumberg EA. Endocrine and metabolic aspects of tuber-culosis. Microbiol Spectr. 2017;5 (1):10.

5.

Park HD, Park SJ, Choi YM, Kang JH. Adrenomyeloneuropathy presenting with adrenal insufficiency. Ann Rehab Med 2013;37(4):563-6.

6. Benner BJM, Alsma J, Feelders RA. Hyponatraemia, and hyperpigmentation in primary adrenal insufficiency. BMJ Case Rep. 2019;12(3):e227200.

7.

Bornstein SR et al. Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-89.

8. Alexandraki KI, Sanpawithayakul K, Grossman A. Adrenal insufficiency. Endotext. South Dartmouth. 2015.

9.

Dineen R, Thompson CJ, Sherlock M. Adrenal crisis: prevention and management in adult patients. Ther Adv Endocrinol Metab. 2019;10:1–12

10. Laway, B.A., Mir, S.A., Ganie, M.A. et al. Nonreversal of adrenal hypofunction after treatment of adrenal tuberculosis. Egypt J Intern Med 2015; 27 42–4.

11. Zeding Z, Liu L, Wang C, Zhang J, Zen Y, et al. (2022) A retrospective analysis of 25 cases of addison's disease caused by adrenal tuberculosis in tibet and review of related literature. J Endocrinol Res Stu 2(1): 101.

12. Kusuki K, Watanabe S, Mizuno Y. Tuberculous Addison's disease with increased hydrocortisone requirements due to administration of rifampicin. BMJ Case Rep. 2019;12(3):e228293.

Downloads

Published

01-07-2024

How to Cite

1.
Ira Laurentika, Em Yunir, Tri Juli Edi Tarigan, Agnes Stephanie, Robert Shinto, Taufik Agung. Primary Adrenal Insufficiency due to Tuberculosis Infection Pitfalls in Diagnosis and Management. InaJEMD [Internet]. 2024 Jul. 1 [cited 2026 Jul. 15];1(1):41-7. Available from: https://inajemd.pbperkeni.or.id/index.php/journal/article/view/vol1-no1-section6

Similar Articles

1-10 of 29

You may also start an advanced similarity search for this article.