Kosin Med J.  2013 Dec;28(2):183-186. 10.7180/kmj.2013.28.2.183.

A Case of Adrenal Tuberculosis with Atypical Clinical Manifestation

• Son MH
• Park JK
• Hwang HS
• Kim BH
• Jung ED
• Choi YS

• KMID: 1993579
• DOI: http://doi.org/10.7180/kmj.2013.28.2.183

Abstract

Addison's disease is a rare disorder that causes fatigue, genral weakness, weight loss, pigmentation due to adrenal hypofunction and it's underlying causes are various. We report a case of 42-year-old man with fatigue, generalized cutaneous pigmentation. Computed tomography showed bilateral adrenal enlargement, but no calcification. Adrenal tuberculosis was established by ultrasound-guided fine needle aspiration biopsy.

Keyword

Addison's disease; Adrenal tuberculosis

MeSH Terms

Addison Disease
Adult
Biopsy
Biopsy, Fine-Needle
Fatigue
Humans
Pigmentation
Tuberculosis*
Weight Loss

Figure

• 

  Fig. 1. Dynamic adrenal gland computed tomography. Both adrenal gland show nodular hyperplasia and enlargement. (A) pre-enhance phase, (B) arterial phase.

• 

  Fig. 2. Skin punch biopsy. The melanocytes are mildly increased in number (HE stain, × 400).

• 

  Fig. 3. Adrenal gland, Fine needle aspiration biopsy. There is a caseation necrosis which is suspicious of tuberculosis (HE stain, × 400).

Reference

1.Choi DY., Kim HS., Lee CK., Lim BS., Jung SJ., Tae CH. A case report of Addison's disease. Korean J Med. 1968. 11:455–60.

2.Park WY., Kee CS., Cho SK., Choi YK. A case report of Addison's disease. Korean J Med. 1971. 14-3:63–7.

3.Oelkers W. Adrenal insufficiency. N Engl J Med. 1996. 335:1206–12.

4.Sung SK., Kwon YJ., Lee BW., Kim DM., Yoo HJ. Clinical Review of Addison's Disease in Korea Previously Reported 14 Cases in Korea and 6 New Cases at National Medical Center. J Korean Soc Endocrinol. 1987. 2:189–93.

5.Ja Young Lee, Jee Hee Kim, Dong Joon Lim, Sung Dae Moon, Je Ho Han. A case of Addison's disease due to tuberculosis: pathologic confirmation by laparoscopic biopsy. Korean J Med. 2008. 75:704–8.

6.Kim JY., Jeon HC., Kim KY., Cha SE., Cha SE., Choi HS, et al. A case of Addison's disease due to tuberculosis: Pathological confirmation by fine-needle aspiration biopsy. J Korean Soc Endocrinol. 1995. 10:306–10.

7.Schultz CL. CT and MR of the adrenal glands. Seminars in ultrasound CT and MRI. 1986. 7:219–33.

8.Lam KY., Lo CY. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin Endocrinol (Oxf). 2001. 54:633–9.

9.Post FA., Soule SG., Willcox PA., Levitt NS. The spectrum of endocrine dysfunction in active pulmonary tuberculosis. Clin Endocrinol (Oxf). 1994. 40:367–71.

10.Vita JA., Silverberg SJ., Goland RS., Austin JHM., Knowlton AI. Clinical clues to the cause of Addison's disease. Am J Med. 1985. 78:461–6.