Endocrine Abstracts

During the past decades, incidence of adrenal tuberculosis has been greatly decreased due to the introduction of antituberculosis drugs. It is reported that primary adrenal insufficiency (PAI) results from adrenal tuberculosis accounting for only 15%–20% patients in developed countries. Adrenal tuberculosis is the major cause of chronic PAI especially in developing countries. A 53 year old man presented with a 3 month history of generalized weakness, anorexia, weight loss and dizziness. His past medical history was unremarkable. Physical examination showed hypotension (85/60 mmHg) and nevuses in many parts of body. Laboratory evaluation was significant for hyponatremia, hyperkalemia and mildly increased creatinin and C-reactive protein values. Cortisol level was 3.8 mcg/dl with an ACTH level of 662 pcg/ml which was consistent with the diagnosis of primary adrenal insufficiency. A contrast enhanced abdomen magnetic resonance imaging (MRI) showed a mass,measuring 20×15 mm in the medial limb of right adrenal gland and a mass measuring 22×25 mm in the lateral limb of right adrenal gland and masses measuring 20×15 mm and 20×14 mm at the level of the left adrenal gland corpus. The masses showed heterogenity and necrotic components after contrast. Thorax CT showed sequelae findigs on apex of the right lung probably due to tuberculosis. Due to the possibility of adrenal malignancy or metastasis 18F-fluorodeoxyglucose positron emission tomography (FDG PET) CT scan was additionally performed. FDG PET-CT scan showed uptake only in the adrenal glands on both sides. Tru-cut biopsy was performed on the right adrenal gland. Cytology revealed necrotising granulomatous reaction supporting tuberculosis. A diagnosis of adrenal insufficiency secondary to tuberculosis was made, and treatment with hydrocortisone, fludrocortisone for adrenal insufficiency and antitubercular therapy was started. After 2 months the masses were not seen on the left adrenal gland, size of the masses on the right adrenal gland was decreased. He is still using hydrocortisone, fludrocortisone and antitubercular therapy.