Lam K Y, Lo C Y
Faculty of Medicine, University of Hong Kong, Hong Kong.
Clin Endocrinol (Oxf). 2001 May;54(5):633-9. doi: 10.1046/j.1365-2265.2001.01266.x.
Tuberculosis is potentially fatal and adrenal gland involvement is uncommonly reported. The aims of the current study were to define the characteristics of tuberculosis in hospitalized patients and to analyse the features of adrenal tuberculosis.
Retrospective analysis of autopsies and adrenalectomies.
13,762 patients (13492 at autopsies and 270 at adrenalectomy).
The presence of active tuberculosis, the predisposing factors, the pathological features and organs of involvement were examined.
Active tuberculosis was present in 871 patients (6.5% of all 13492 autopsies). It was first diagnosed in 70% of these patients during autopsy. Cancers and a history of recent major operations were the 2 main concomitant factors in the patients with tuberculosis. Extra-pulmonary tuberculosis was seen in 261 patients (30%). The five most common extra-pulmonary sites of tuberculosis were the liver, spleen, kidney, bone and adrenal gland. Adrenal tuberculosis was seen in 52 of the 871 patients (6%) with active tuberculosis at autopsy and in 3 patients at adrenalectomy. The adrenal gland was the only organ involved by active tuberculosis in 14 of these 55 patients (25%; 35 men, 20 women). Tuberculosis was evident on macroscopic examination of the adrenal glands in 46% of the patients. On histological examination, caseous necrosis and granulomatous inflammation with Langhan's giant cells were seen in 71% and 40% of patients, respectively. Seven patients presented with signs and symptoms of Addison's disease due to bilateral adrenal involvement. Langhan's giant cells were frequently seen in histological sections and bilateral enlargement of the adrenal glands was often noted. Fine needle aspiration cytology was not useful for diagnosing adrenal tuberculosis.
Unexpected and extra-pulmonary tuberculosis such as adrenal tuberculosis has been a common problem. A high index of suspicion, correct diagnosis and proper treatment are essential for the management of tuberculosis.
结核病具有潜在致命性，肾上腺受累的报道并不常见。本研究旨在明确住院患者结核病的特征，并分析肾上腺结核的特点。
对尸检和肾上腺切除术进行回顾性分析。
13762例患者（13492例尸检患者和270例肾上腺切除患者）。
检查活动性结核病的存在情况、易感因素、病理特征和受累器官。
871例患者存在活动性结核病（占所有13492例尸检患者的6.5%）。其中70%的患者在尸检时首次被诊断出。癌症和近期大手术史是结核病患者的两个主要伴随因素。261例患者（30%）出现肺外结核。结核病最常见的五个肺外部位是肝脏、脾脏、肾脏、骨骼和肾上腺。在871例尸检时有活动性结核病的患者中，52例（6%）发现肾上腺结核，肾上腺切除患者中有3例发现肾上腺结核。在这55例患者中，14例（25%；35例男性，20例女性）肾上腺是唯一受累于活动性结核病的器官。46%的患者肾上腺大体检查可见结核病表现。组织学检查显示，分别有71%和40%的患者出现干酪样坏死和伴有朗汉斯巨细胞的肉芽肿性炎症。7例患者因双侧肾上腺受累出现艾迪生病的体征和症状。组织切片中经常可见朗汉斯巨细胞，肾上腺双侧肿大也较为常见。细针穿刺细胞学检查对肾上腺结核的诊断无用。
诸如肾上腺结核等意外和肺外结核一直是个常见问题。高度怀疑、正确诊断和恰当治疗对于结核病的管理至关重要。
