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Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis
SUMMARY: Primary adrenal insufficiency is a rare disease and can masquerade as other conditions; therefore, it is sometimes incorrectly diagnosed. Herein, we reported the case of a 39-year-old Vietnamese male with primary adrenal insufficiency due to bilateral adrenal tuberculosis. The patient prese...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Bioscientifica Ltd
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686179/ https://www.ncbi.nlm.nih.gov/pubmed/34904571 http://dx.doi.org/10.1530/EDM-21-0093 |
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author | Tran, Nam Quang Phan, Chien Cong Doan, Thao Thi Phuong Tran, Thang Viet |
author_facet | Tran, Nam Quang Phan, Chien Cong Doan, Thao Thi Phuong Tran, Thang Viet |
author_sort | Tran, Nam Quang |
collection | PubMed |
description | SUMMARY: Primary adrenal insufficiency is a rare disease and can masquerade as other conditions; therefore, it is sometimes incorrectly diagnosed. Herein, we reported the case of a 39-year-old Vietnamese male with primary adrenal insufficiency due to bilateral adrenal tuberculosis. The patient presented to the emergency room with acute adrenal crisis and a 3-day history of nausea, vomiting, epigastric pain, and diarrhoea with a background of 6 months of fatigue, weight loss, and anorexia. Abdominal CT revealed bilateral adrenal masses. Biochemically, unequivocal low morning plasma cortisol (<83 nmol/L) and high plasma adrenocorticotropic hormone levels were consistent with primary adrenal insufficiency. There was no evidence of malignancy or lymphoma. As the patient was from a tuberculosis-endemic area, extra-adrenal tuberculosis was excluded during the work up. A retroperitoneal laparoscopic left adrenalectomy was performed, and tuberculous adrenalitis was confirmed by the histopathological results. The patient was started on antituberculous therapy, in addition to glucocorticoid replacement. In conclusion, even without evidence of extra-adrenal tuberculosis, a diagnosis of bilateral adrenal tuberculosis is required. A histopathological examination has a significant role along with clinical judgement and hormonal workup in establishing a definitive diagnosis of adrenal tuberculosis without evidence of active extra-adrenal involvement. LEARNING POINTS: Primary adrenal insufficiency can be misdiagnosed as other mimicking diseases, such as gastrointestinal illness, leading to diagnostic pitfalls. Adrenal insufficiency can be confirmed with significantly low morning plasma cortisol levels of <83 nmol/L without a dynamic short cosyntropin stimulation test. Tuberculous adrenalitis is an uncommon treatable condition; however, it remains an important cause of primary adrenal insufficiency, especially in developing countries. In the absence of extra-adrenal involvement, adrenal biopsy plays a key role in the diagnostic process. Alternatively, adrenalectomy for histopathological purposes should be considered if CT scan-guided fine needle aspiration is infeasible in cases of small adrenal masses. |
format | Online Article Text |
id | pubmed-8686179 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-86861792021-12-23 Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis Tran, Nam Quang Phan, Chien Cong Doan, Thao Thi Phuong Tran, Thang Viet Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease SUMMARY: Primary adrenal insufficiency is a rare disease and can masquerade as other conditions; therefore, it is sometimes incorrectly diagnosed. Herein, we reported the case of a 39-year-old Vietnamese male with primary adrenal insufficiency due to bilateral adrenal tuberculosis. The patient presented to the emergency room with acute adrenal crisis and a 3-day history of nausea, vomiting, epigastric pain, and diarrhoea with a background of 6 months of fatigue, weight loss, and anorexia. Abdominal CT revealed bilateral adrenal masses. Biochemically, unequivocal low morning plasma cortisol (<83 nmol/L) and high plasma adrenocorticotropic hormone levels were consistent with primary adrenal insufficiency. There was no evidence of malignancy or lymphoma. As the patient was from a tuberculosis-endemic area, extra-adrenal tuberculosis was excluded during the work up. A retroperitoneal laparoscopic left adrenalectomy was performed, and tuberculous adrenalitis was confirmed by the histopathological results. The patient was started on antituberculous therapy, in addition to glucocorticoid replacement. In conclusion, even without evidence of extra-adrenal tuberculosis, a diagnosis of bilateral adrenal tuberculosis is required. A histopathological examination has a significant role along with clinical judgement and hormonal workup in establishing a definitive diagnosis of adrenal tuberculosis without evidence of active extra-adrenal involvement. LEARNING POINTS: Primary adrenal insufficiency can be misdiagnosed as other mimicking diseases, such as gastrointestinal illness, leading to diagnostic pitfalls. Adrenal insufficiency can be confirmed with significantly low morning plasma cortisol levels of <83 nmol/L without a dynamic short cosyntropin stimulation test. Tuberculous adrenalitis is an uncommon treatable condition; however, it remains an important cause of primary adrenal insufficiency, especially in developing countries. In the absence of extra-adrenal involvement, adrenal biopsy plays a key role in the diagnostic process. Alternatively, adrenalectomy for histopathological purposes should be considered if CT scan-guided fine needle aspiration is infeasible in cases of small adrenal masses. Bioscientifica Ltd 2021-11-26 /pmc/articles/PMC8686179/ /pubmed/34904571 http://dx.doi.org/10.1530/EDM-21-0093 Text en © The authors https://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Unique/Unexpected Symptoms or Presentations of a Disease Tran, Nam Quang Phan, Chien Cong Doan, Thao Thi Phuong Tran, Thang Viet Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
title | Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
title_full | Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
title_fullStr | Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
title_full_unstemmed | Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
title_short | Bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
title_sort | bilateral adrenal masses due to tuberculosis: how to diagnose without extra-adrenal tuberculosis |
topic | Unique/Unexpected Symptoms or Presentations of a Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686179/ https://www.ncbi.nlm.nih.gov/pubmed/34904571 http://dx.doi.org/10.1530/EDM-21-0093 |
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