Endocrine Abstracts

Introduction: Adrenal failure due to tuberculosis is rarely seen nowadays. There are few reports in the literature suggesting that adrenal insufficiency may improve with anti-tuberculosis therapy during the active phase of the disease. Herein, we presented a case of reversible adrenal failure in a patient with active tuberculosis.

Case report: A 50-years-old-female patient admitted to our clinics with the complaints of weakness and darkening of the skin. She had been receiving anti-tuberculosis treatment for the last 8 months. On physical examination, there was hypotension and hyperpigmentation. The laboratory findings were as follows: serum glucose, 72 mg/dl; creatinine, 0.9 mg/dl; sodium, 132 mmol/l; potassium, 4.9 mmol/l; cortisol, 8 μg/dl; and ACTH, 802 pg/ml. In the cosyntropin stimulation test, there wasn’t cortisol response (30th min cortisol was 10 μg/dl and 60th min was 11 μg/dl). We started glucocorticoid therapy. In the magnetic resonance imaging, thickness of both adrenal glans were increased. Anti-21 hydroxylase antibody was negative. Anti-tuberculosis treatment were stopped at the 9th month. We repeated the cosyntropin test one month after the therapy was stopped. We detected that there was a positive cortisol response to ACTH (cortisol was 25 μg/dl at the 30th min and 29 μg/dl at the 60th min). We stopped the glucocorticoid since we thought adrenal failure improved.

Conclusion: We suggest that patients who are diagnosed to have adrenal failure due to tuberculosis should be reevaluated after completion of anti-tuberculosis treatment with dynamic tests.