Serter Rüstü, Koç Gönül, Demirbas Berrin, Culha Cavit, Ongören Ali Ulvi, Ustün Hüseyin, Aral Yalçin
Department of Endocrinology and Metabolism, Ankara Training and Research Hospital of The Ministry of Health, Ankara, Turkey.
Endocr Pract. 2003 Mar-Apr;9(2):157-61. doi: 10.4158/EP.9.2.157.
To describe a patient admitted with acute adrenocortical failure and a right adrenal mass without evidence of tuberculosis, who was ultimately diagnosed with isolated adrenal tuberculosis after postoperative histopathologic evaluation.
A case report is presented, with clinical, laboratory, and imaging findings. We also discuss potential factors that may complicate the diagnosis of tuberculosis.
A 61-year-old man was admitted with symptoms and signs of acute adrenal crisis. The patient had an erythrocyte sedimentation rate of 30 mm in 1 hour, a negative tuberculin skin test, a 6-cm right adrenal mass, and left adrenal nodularity in conjunction with normal findings on a computed tomographic scan of the chest. He recovered dramatically after intravenous corticosteroid treatment. Investigation, including acid-fast staining and cultures for tuberculosis of all available specimens, gastroduodenoscopy and rectosigmoidoscopy, intestinal x-ray imaging, and autoantibody studies, did not disclose the diagnosis. Subsequently, bilateral adrenalectomy revealed isolated tuberculosis of the adrenal glands on histopathologic evaluation. Quadruple antituberculous therapy was initiated, and continued follow-up of the patient is scheduled.
Our case indicates that acute or chronic adrenocortical failure can occur as a result of tuberculosis of the adrenal gland, despite the absence of clinical and laboratory evidence of tuberculosis.
描述一名因急性肾上腺皮质功能衰竭入院且右肾上腺有肿块但无结核病证据的患者，该患者术后经组织病理学评估最终被诊断为孤立性肾上腺结核。
报告一例病例，并给出临床、实验室和影像学检查结果。我们还讨论了可能使结核病诊断复杂化的潜在因素。
一名61岁男性因急性肾上腺危象的症状和体征入院。患者红细胞沉降率为1小时30毫米，结核菌素皮肤试验阴性，右肾上腺有一个6厘米的肿块，左肾上腺有结节，同时胸部计算机断层扫描结果正常。静脉注射皮质类固醇治疗后他恢复显著。包括对所有可用标本进行抗酸染色和结核培养、胃十二指肠镜检查和直肠乙状结肠镜检查、肠道X线成像以及自身抗体研究在内的检查均未明确诊断。随后，双侧肾上腺切除术的组织病理学评估显示肾上腺存在孤立性结核。开始四联抗结核治疗，并安排对患者进行持续随访。
我们的病例表明，尽管缺乏结核病的临床和实验室证据，但肾上腺结核仍可导致急性或慢性肾上腺皮质功能衰竭。
