A case report: Addison disease caused by adrenal tuberculosis

Area of Science:

• Endocrinology
• Infectious Diseases
• Pathology

Background:

• Addison's disease, or primary adrenal insufficiency, can manifest with non-specific symptoms like hyperpigmentation and fatigue.
• Adrenal tuberculosis is a rare but significant cause of Addison's disease, particularly in endemic regions.
• Bilateral adrenal hyperplasia can be seen in various forms of adrenal insufficiency.

Observation:

• A middle-aged male presented with generalized malaise, depression, and characteristic skin and oral mucous membrane hyperpigmentation.
• Initial investigations confirmed adrenal insufficiency, leading to a diagnosis of Addison's disease.
• Imaging revealed bilateral adrenal hyperplasia, with initial tuberculosis testing yielding negative results.

Findings:

• Laparoscopic adrenalectomy was performed for diagnostic and therapeutic purposes.
• Gross pathological examination of the adrenal glands showed multiple areas of caseous necrosis.
• Microscopic examination revealed Langhan's giant cells, pathognomonic for tuberculosis, confirming adrenal tuberculosis as the etiology of Addison's disease.

Implications:

• This case highlights the importance of considering adrenal tuberculosis in the differential diagnosis of Addison's disease, even with negative initial screening.
• Pathological confirmation remains crucial for diagnosing rare etiologies of adrenal insufficiency.
• Adrenalectomy, while treating the symptoms, necessitates lifelong glucocorticoid and mineralocorticoid replacement therapy.