Endocrine Abstracts

Delay in diagnosis of adrenal insufficiency is common. About 47% of patients have symptoms for over 1 year and 20% for over 5 years before diagnosis. Autoimmunity is the most common aetiology for Primary Adrenal Insufficiency (PAI) in developed countries. But up to 10–20% of PAI could be due to TB.

We present an interesting case of 42 year old Afro Caribbean male with isolated adrenal TB. He had 2 year history of nonspecific illness including reduced appetite, weight loss and intermittent fever. He was referred as an emergency due to neutropaenia. After extensive inpatient investigations, he was discharged with probable viral infection and neutropaenia related to ethnicity. He denied any exposure to TB and his sputum and bone marrow aspirates were negative for TB. His T-spot has come back as reactive. However there was no evidence of active TB at other sites and this was thought to be a latent infection and was not treated. Subsequent CT CAP for weight loss revealed significant bilateral adrenal hyperplasia with some calcifications. Further investigations confirmed PAI. This along with radiological features raised suspicion for Adrenal TB and he was started on treatment. He has now completed 6 months anti-tuberculous therapy and on follow up imaging, there is almost complete resolution of radiological abnormalities in adrenal glands. He remains on Hydrocortisone and Fludrocortisone.

High degree of clinical suspicion is necessary to diagnose adrenal TB, especially when there is no extra adrenal involvement. This should be considered in anyone with PAI in the presence of bilaterally enlarged adrenal glands. 12% of patients with adrenal TB have no evidence of active TB elsewhere. Adrenal biopsy would also be helpful in this scenario.