Endocrine Abstracts

Addison’s disease is most commonly caused by autoimmune adrenalitis. But, adrenal tuberculosis is still major cause in developing countries, that usually caused by hematogenous spread of pulmonary tuberculosis. Systemic tuberculosis causing Addison’s disease has been rarely reported. We present a case of Addison’s disease caused by systemic disseminated tuberculosis which was mimicked as lymphoma on F-18 FDG PET-CT (PET-CT).

Sixty eight-year-old woman visited with dyspnea for 3 days. She presented with about 10 kg of weight loss, general weakness, and nausea for 3 months. There were no history of pulmonary tuberculosis and medications like steroids. Her skin and oral mucosa were hyperpigmented and non-tender enlarged lymph nodes were palpated in both axilla and inguinal area. The levels of serum cortisol (<1.0 μg/dl) and aldosterone (<10 pg/ml) were low and the level of serum ACTH was high (843.50 pg/ml). Cortisol response was decreased in rapid ACTH stimulation test. Then, she was prescribed prednisolone 15 mg/day and fludrocortisone 0.05 mg/day. After few days of medication, her symptoms were started to improve. On fluid analysis of left pleural effusion, there were no evidences of tuberculous pleurisy or malignant cells. Multiple lesions with increased FDG uptake were seen in PET-CT: neck, intrathoracic, intraabdominal, axillary, iliac and inguinal lymph nodes, both palatine tonsils, adenoids, and both adrenal glands. In the view of these results, the lymphoma was highly suggested. The results of Core needle biopsy of left axillary lymph node was chronic granulomatous inflammation with negative PCR for M. tuberculosis or non-tuberculous mycobacterium. With positive result of Mantoux skin test, we clinically diagnosed as tuberculosis and started empirical antituberculous treatment. After 2 months of treatment, left pleural effusion was disappeared. After 9 months of treatment, the FDG uptaken lesions were disappeared in follow-up PET-CT. Now, she is free of symptoms with prednisolone 5 mg/day and fludrocortisone 0.05 mg/day.