Lin S Y, Chang C L, Jap T S, Lin H D, Won J G
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Mar;61(3):170-4.
Genitourinary tuberculosis (TB) rarely involves the adrenal gland. A 67-year-old man presented with progressively hyperpigmented skin and an enlarged mass over both testes. Early morning plasma cortisol concentration was low and adrenocorticotropic hormone (ACTH) concentration was high. A rapid ACTH stimulation test revealed the absence of plasma cortisol response and confirmed a diagnosis of primary adrenocortical insufficiency. An abdomen computed tomography (CT) scan disclosed enlargement of the right adrenal gland and punctuate calcification over the left one. This is compatible with tuberculous adrenalitis. Currettage biopsy of the prostate demonstrated chronic granulomatous inflammation with Langerhan's giant cells, but without TB bacilli. Anti-TB treatment, in addition to glucocorticoid and mineralocorticoid replacement, was administered. The testicular mass decreased progressively though the results of a subsequent ACTH stimulation test, six months later, disclosed no significant change. A follow-up CT scan, one and a half years later, showed a decrease in the size of the right adrenal mass.
泌尿生殖系统结核很少累及肾上腺。一名67岁男性出现皮肤逐渐色素沉着以及双侧睾丸肿大。清晨血浆皮质醇浓度低而促肾上腺皮质激素（ACTH）浓度高。快速ACTH刺激试验显示血浆皮质醇无反应，确诊为原发性肾上腺皮质功能不全。腹部计算机断层扫描（CT）显示右肾上腺增大，左肾上腺有斑点状钙化。这与结核性肾上腺炎相符。前列腺刮除活检显示有含朗汉斯巨细胞的慢性肉芽肿性炎症，但未发现结核杆菌。除了给予糖皮质激素和盐皮质激素替代治疗外，还进行了抗结核治疗。睾丸肿块逐渐缩小，尽管6个月后后续的ACTH刺激试验结果显示无明显变化。1年半后的随访CT扫描显示右肾上腺肿块大小减小。
