Vorasayun Thanyaporn, Pengkhum Pornrumpa, Thavaraputta Subhanudh, Porntharukchareon Thachanun, Plongla Rongpong, Kongboonvijit Sasiprang, Snabboon Thiti, Parksook Wasita Warachit, Wannachalee Taweesak, Sunthornyothin Sarat
Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Division of Endocrinology and Metabolism, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Endocrinol (Oxf). 2025 Aug;103(2):137-146. doi: 10.1111/cen.15246. Epub 2025 Apr 9.
Adrenal infections can lead to adrenal insufficiency (AI). Commonly reported pathogens are Histoplasma capsulatum and Mycobacterium tuberculosis (TB), which can cause similar clinical presentations, yet require different specific treatments. We aim to evaluate clinical presentations, imaging characteristics, and AI prevalence in adrenal infections caused by these pathogens.
Retrospective study.
Thirty-five patients with microbiologically confirmed adrenal histoplasmosis and TB at two referral centers in Bangkok, Thailand.
Thirty-one patients (88.5%) had adrenal histoplasmosis, 3 (8.5%) had adrenal TB, and 1 (3.0%) had coinfection. Most patients were non-HIV (97%) males (91%), with a mean age of 64 years. Common symptoms were anorexia and weight loss (91%), with 26% presenting with adrenal crisis. Extra-adrenal infections occurred in 45% of histoplasmosis, 67% of TB, and 100% of coinfections, with 10% of adrenal histoplasmosis patients having concurrent extra-adrenal TB infection. Bilateral adrenal abnormalities were seen in 91%, and all patients with unilateral lesions later developed contralateral involvement. Adrenal lesions ranged from enlargement to mass sized 9.8 cm. The prevalence of AI was 74% (histoplasmosis 73%, TB and coinfection 100%). Over a median follow-up of 22 months, all patients with AI remained on glucocorticoid supplements.
Adrenal histoplasmosis and TB primarily affected non-HIV males. Most patients presented with bilateral adrenal masses. The prevalence of AI was high and likely persistent despite specific treatment. Extra-adrenal infections were common in TB and coinfection but were insufficient to determine adrenal infection etiology, highlighting the need for tissue diagnosis.
肾上腺感染可导致肾上腺功能不全（AI）。常见的病原体是荚膜组织胞浆菌和结核分枝杆菌（TB），它们可引起相似的临床表现，但需要不同的特异性治疗。我们旨在评估由这些病原体引起的肾上腺感染的临床表现、影像学特征和AI患病率。
回顾性研究。
泰国曼谷两个转诊中心的35例经微生物学确诊的肾上腺组织胞浆菌病和结核病患者。
31例（88.5%）患有肾上腺组织胞浆菌病，3例（8.5%）患有肾上腺结核，1例（3.0%）为合并感染。大多数患者为非HIV感染者（97%），男性（91%），平均年龄64岁。常见症状为厌食和体重减轻（91%），26%出现肾上腺危象。45%的组织胞浆菌病、67%的结核病和100%的合并感染患者发生肾上腺外感染，10%的肾上腺组织胞浆菌病患者同时患有肾上腺外结核感染。91%的患者双侧肾上腺异常，所有单侧病变患者后来均出现对侧受累。肾上腺病变范围从增大到9.8厘米大小的肿块。AI患病率为74%（组织胞浆菌病73%，结核病和合并感染100%）。在中位随访22个月期间，所有AI患者均继续服用糖皮质激素补充剂。
肾上腺组织胞浆菌病和结核病主要影响非HIV男性。大多数患者表现为双侧肾上腺肿块。AI患病率很高，尽管进行了特异性治疗，但可能持续存在。肾上腺外感染在结核病和合并感染中很常见，但不足以确定肾上腺感染的病因，突出了组织诊断的必要性。
