Schult-Montoya Sandra, Lindo-Pérez Felipe Ricardo
Instituto Nacional de Salud del Niño, Lima, Perú.
Universidad Nacional Mayor de San Marcos, Lima, Perú.
Rev Peru Med Exp Salud Publica. 2025 Jun 9;42(1):92-96. doi: 10.17843/rpmesp.2025.421.14092.
Primary adrenal insufficiency is the result of impaired steroid synthesis, adrenal destruction or abnormal development of the adrenal gland affecting the adrenal cortex. Tuberculosis is one of the main causes in developing countries. We present the case of a 10-year-old male patient diagnosed with adrenal insufficiency two years earlier with regular treatment, who was admitted for adrenal crisis. A thoraco-abdominal tomography was carried out during hospitalization, which showed cylindrical and traction bronchiectasis associated with cicatricial atelectasis in the right upper pulmonary lobe, enlarged adrenal glands with foci of calcification, as well as a dense posterior perivertebral mediastinal collection also involving vertebral bodies with lytic resorptive foci, findings consistent with systemic tuberculosis. Treatment for tuberculosis started based on this diagnosis. During course of the disease, the first phase was completed with four drugs, and the second phase included isoniazid and rifampicin with favorable clinical response.
原发性肾上腺皮质功能减退是类固醇合成受损、肾上腺破坏或肾上腺异常发育影响肾上腺皮质的结果。在发展中国家，结核病是主要病因之一。我们报告一例10岁男性患者，两年前被诊断为肾上腺皮质功能减退并接受常规治疗，此次因肾上腺危象入院。住院期间进行了胸腹部断层扫描，结果显示右上肺叶有柱状和牵拉性支气管扩张并伴有瘢痕性肺不张，肾上腺增大且有钙化灶，以及后纵隔椎旁致密影，累及椎体并有溶骨性吸收灶，这些表现符合系统性结核病。基于这一诊断开始了抗结核治疗。在疾病过程中，第一阶段使用四种药物完成治疗，第二阶段使用异烟肼和利福平，临床反应良好。
