Archambeaud-Mouveroux F, Fressinaud C, Sautereau D, Suraneti S, Treves R, Pillegand B, Catanzano G
Service de médecine interne B-endocrinologie, hôpital du Cluzeau, Limoges.
Rev Med Interne. 1988 Mar-Apr;9(2):137-44. doi: 10.1016/s0248-8663(88)80112-7.
Two cases of Addison's disease secondary to active adrenal tuberculosis are reported. Computed tomography showed hypertrophy of the adrenal gland, which was bilateral in one case and unilateral in the other. Repeat computed tomography scans during antituberculous chemotherapy demonstrated a progressive change of the adrenals toward atrophy and calcification, while the adrenal function remained impaired. The authors recall that adrenal tuberculosis may be unilateral first, then bilateral, and that the gland is initially hypertrophic before hormonal deficiency appears; later on, adrenal atrophy and calcification develop. Computed tomography seems to be useful in the aetiological diagnosis of Addison's disease. Moreover, it helps in determining whether or not antituberculous therapy is indicated, which is not always easy to decide in the absence of "active" focus. The finding, with or without positive tuberculin skin tests, of an adrenal hypertrophy unexplainable by any other pathology (e.g. metastasis, histoplasmosis) should call for antituberculous treatment, especially since it sometimes results in recovery of adrenal function.
报告了两例继发于活动性肾上腺结核的艾迪生病病例。计算机断层扫描显示肾上腺肥大，其中一例为双侧，另一例为单侧。在抗结核化疗期间重复进行计算机断层扫描显示，肾上腺逐渐向萎缩和钙化转变，而肾上腺功能仍受损。作者回顾，肾上腺结核可能先为单侧，然后发展为双侧，并且在出现激素缺乏之前肾上腺最初是肥大的；随后，肾上腺萎缩和钙化出现。计算机断层扫描似乎有助于艾迪生病的病因诊断。此外，它有助于确定是否需要进行抗结核治疗，在没有“活动性”病灶的情况下，这并不总是容易决定的。无论结核菌素皮肤试验是否呈阳性，发现无法用任何其他病理情况（如转移、组织胞浆菌病）解释的肾上腺肥大都应进行抗结核治疗，特别是因为它有时会导致肾上腺功能恢复。
