Endocrine Abstracts

A 37-year-old man presented with persistent right hip pain and night sweats. CT of chest, abdomen, and pelvis revealed a right iliopsoas abscess from which mycobacterium species tuberculosis isolated. He commenced quadruple agent anti tuberculous chemotherapy. Repeat CT 1 year later showed complete resolution of the abscess but a 3.3×1.7 cm mass replacing the right adrenal gland. Considered likely to represent healed tuberculous lesion, treatment completed, and patient discharged. He was referred back to the infectious diseases service eight months later with left loin pain. There was concern over recrudescence of TB. CT showed enlargement of the right adrenal mass (3×3.7 cm) with adjacent liver hypodensity. Given the full remission of tuberculous infection he was referred to endocrinology for further investigation. Clinical examination, including blood pressure, was entirely normal. Blood and urine testing was in keeping with a non-functioning adrenal mass. There was concern however about the possibility of malignancy given the complete remission of infection. He underwent laparoscopic right adrenalectomy. The Histopathological diagnosis was tuberculous periadrenal inflammation. No bacilli were present and the ZN stain was negative, as was the TB culture. It was concluded that the adrenal mass represented a sterile lesion of inflammatory change consequent to dead tubercle bacilli.

Lessons: In many countries, tuberculosis remains a major cause of adrenal failure. Most cases of adrenal tuberculosis are found 10–15 years after the initial infection. Spread of tuberculosis to adrenals is usually bilateral, with both adrenals markedly enlarged, while adrenal carcinoma usually affects only one gland. Approximately two thirds of adrenal cortical carcinomas cause symptoms by producing high levels of the adrenal cortex hormones. Adult adrenocortical carcinomas are aggressive tumours with a very poor prognosis. The prognosis depends on the stage, early identification, and intervention is required.