Anaforoğlu Inan, Algün Ekrem, Inceçayır Omer, Siviloğlu Ciğdem, Caymaz Ismail
Department of Endocrinology and Metabolism, Trabzon Numune Education and Research Hospital, 61000 Trabzon, Turkey.
Case Rep Med. 2012;2012:574845. doi: 10.1155/2012/574845. Epub 2012 May 9.
A 51-year-old man developed anorexia, dizziness, nausea, vomiting, and weight loss. He had orthostatic hypotension, hyponatremia, hyperkalemia, and hypocortisolemia, and the diagnosis of adrenal insufficiency was made. Magnetic resonance imaging (MRI) showed asymmetrically enlarged adrenal glands. Biopsy of a hypoechoic, enlarged, inguinal lymph node showed caseating granulomas. Lumbar MRI showed vertebral body height loss and abnormal signal in L1 and L2; vertebral biopsy showed chronic, necrotic, caseating granulomatous inflammation consistent with tuberculous osteomyelitis. Clinical improvement occurred with isoniazid, rifampicin, pyrazinamide, and corticosteroids. The differential diagnosis of adrenal insufficiency should include tuberculosis, especially in geographic regions where tuberculosis is endemic.
一名51岁男性出现厌食、头晕、恶心、呕吐及体重减轻。他有体位性低血压、低钠血症、高钾血症及皮质醇减少症，诊断为肾上腺功能不全。磁共振成像（MRI）显示肾上腺不对称增大。对一个低回声、增大的腹股沟淋巴结活检显示干酪样肉芽肿。腰椎MRI显示L1和L2椎体高度降低及信号异常；椎体活检显示与结核性骨髓炎相符的慢性、坏死性、干酪样肉芽肿性炎症。使用异烟肼、利福平、吡嗪酰胺及皮质类固醇后临床症状改善。肾上腺功能不全的鉴别诊断应包括结核病，尤其是在结核病流行的地区。
