Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
BMC Endocr Disord. 2022 Oct 23;22(1):257. doi: 10.1186/s12902-022-01178-1.
Addison's disease is primary adrenal dysfunction and is characterized by decrease of cortisol level and increase of adrenocorticotropic hormone (ACTH) level. It is known that infection is one of main causes of Addison's disease. Among various infections, tuberculous infection accounts for the majority of them. Recently the number of subjects with non-tuberculous mycobacterial infection has been increased, and the infection can also bring about Addison's disease. Mycobacterium avium complex (MAC) pulmonary disease accounts for the majority of non-tuberculous mycobacterial infection.
An 83-year-old female was suspected of having adrenal failure in our outpatient care and hospitalized in our institution. There was pigmentation in her face, hands and legs, especially in auricle and nail beds in her hands and legs. In rapid ACTH load test (0.25 mg of 1-24 ACTH), cortisol level was not increased at all. An abdominal computed tomography (CT) showed swelling of both adrenal glands accompanied by calcification. QuantiFERON test was negative and mycobacterium tuberculosis complex was negative in PCR test using bronchial lung lavage fluid. These data ruled out the possibility of adrenal tuberculosis. It is known that MAC pulmonary disease accounts for the majority of non-tuberculous mycobacterial infection. In this subject, however, anti-MAC antibody was negative and MAC-related bacteria were not detected in PCR test using bronchial lung lavage fluid. These data ruled out the possibility of MAC pulmonary disease. Mycobacterium abscessus (Mab) was positive in bronchial lung lavage fluid culture. Based on these data, we diagnosed this subject with Addison's disease triggered by infection with mycobacterium abscessus, but not by adrenal tuberculous or MAC pulmonary disease. Decreased sodium level and increased eosinophil number were normalized and appetite loss was markedly mitigated after starting hydrocortisone therapy. A chest CT which was taken about 6 months later showed drastic reduction of consolidation in the upper lobe of the left lung although calcification in the adrenal gland was still observed.
We should bear in mind the possibility of Addison's disease triggered by another type of infection rather than adrenal tuberculosis or MAC pulmonary disease.
艾迪生病是一种原发性肾上腺功能障碍，其特征是皮质醇水平降低和促肾上腺皮质激素（ACTH）水平升高。已知感染是艾迪生病的主要原因之一。在各种感染中，结核感染占大多数。最近，非结核分枝杆菌感染的患者数量有所增加，这种感染也可导致艾迪生病。鸟分枝杆菌复合群（MAC）肺部疾病占非结核分枝杆菌感染的大多数。
一位 83 岁女性因在我院门诊被怀疑肾上腺功能衰竭而住院。她的面部、手部和腿部有色素沉着，尤其是手部和腿部的耳廓和甲床。在快速 ACTH 负荷试验（0.25mg 1-24 ACTH）中，皮质醇水平根本没有增加。腹部 CT 显示双侧肾上腺肿胀伴钙化。定量干扰素释放试验阴性，支气管肺泡灌洗液 PCR 结核分枝杆菌复合群阴性。这些数据排除了肾上腺结核的可能性。已知 MAC 肺部疾病占非结核分枝杆菌感染的大多数。然而，在该患者中，抗 MAC 抗体阴性，支气管肺泡灌洗液 PCR 检测不出 MAC 相关细菌。这些数据排除了 MAC 肺部疾病的可能性。分支杆菌脓肿（Mab）在支气管肺泡灌洗液培养中阳性。根据这些数据，我们诊断该患者患有由分支杆菌脓肿感染引起的艾迪生病，但不是由肾上腺结核或 MAC 肺部疾病引起的。开始使用氢化可的松治疗后，钠水平降低和嗜酸性粒细胞数量增加得到纠正，食欲丧失明显减轻。大约 6 个月后拍摄的胸部 CT 显示，左肺上叶实变明显减少，尽管肾上腺仍有钙化。
我们应该记住，由另一种类型的感染引起的艾迪生病的可能性，而不是肾上腺结核或 MAC 肺部疾病。
