Ikoma Aki, Namai Kazuyuki, Saito Tomoyuki, Kawano Takahisa, Saito Takako, Kasono Keizo, Tamemoto Hiroyuki, Yamada Shigeki, Kawakami Masanobu, Ishikawa San-e
Department of Medicine, Jichi Medical School Omiya Medical Center, Saitama, Japan.
Endocr J. 2004 Oct;51(5):463-6. doi: 10.1507/endocrj.51.463.
The adrenal gland is one of the organs which tuberculosis infects. In most clinical settings bilateral adrenal tuberculosis has been clarified after adrenal insufficiency is overt. On the contrary, active adrenal tuberculosis is rarely detected during the survey of infectious disease. A 68-year-old man was admitted because of intermittent fever. The fever had continued for the last 3 months. The intermittent fever was accompanied with leukocytosis and elevation of C-reactive protein. Serum soluble interleukin-2 receptor was 1920 U/ml, and beta2-microglobulin was 4.0 mg/l. Bacterial cultures of blood, sputa, urine, bone marrow and cerebrospinal fluid did not show any particular bacteria. Mycobacterium tuberculosis was negative in culture of sputa, and there was no tuberculin reaction. Plasma ACTH and serum cortisol were 18.5 pmol/l and 527.0 nmol/l, respectively. Abdominal CT scan showed right adrenal mass with a size of 28 x 20 mm, which was low density and had a well-encapsulated homogenous appearance. After the adrenalectomy, histology verified active adrenal tuberculosis. The intermittent fever disappeared, and white blood cells and C-reactive protein normalized. These findings indicate an atypical, rare case of unilateral, active adrenal tuberculosis closely linked to intermittent fever, and without any other organ involvement.
肾上腺是结核感染的器官之一。在大多数临床情况下，双侧肾上腺结核在肾上腺功能不全明显后才得以明确。相反，在传染病调查期间很少检测到活动性肾上腺结核。一名68岁男性因间歇性发热入院。发热持续了3个月。间歇性发热伴有白细胞增多和C反应蛋白升高。血清可溶性白细胞介素-2受体为1920 U/ml，β2-微球蛋白为4.0 mg/l。血液、痰液、尿液、骨髓和脑脊液的细菌培养未发现任何特殊细菌。痰液培养结核分枝杆菌阴性，结核菌素反应阴性。血浆促肾上腺皮质激素（ACTH）和血清皮质醇分别为18.5 pmol/l和527.0 nmol/l。腹部CT扫描显示右侧肾上腺肿块，大小为28×20 mm，密度低，外观呈边界清晰的均匀性。肾上腺切除术后，组织学证实为活动性肾上腺结核。间歇性发热消失，白细胞和C反应蛋白恢复正常。这些发现表明这是一例非典型、罕见的单侧活动性肾上腺结核病例，与间歇性发热密切相关，且无其他器官受累。
