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Primary Adrenal Insufficiency due to Cryptococcus With Persistent Adrenal Enlargement and Insufficiency
Catherine E Price1, Cynthia Burns1, Joseph A Aloi1
1Wake Forest School of Medicine, Department of Internal Medicine, Division of Endocrinology, Medical Center Blvd, Winston-Salem, North Carolina.
AACE Clinical Case Reports
|December 4, 2023
Summary
This case study highlights a rare cause of adrenal insufficiency (AI): fungal infection. Long-term follow-up is crucial for patients with AI due to disseminated fungal infections to monitor adrenal status and immune function.
Area of Science:
- Endocrinology
- Infectious Diseases
- Mycology
Background:
- Primary adrenal insufficiency (AI) is rarely caused by infiltrative fungal infections.
- Cryptococcal adrenalitis is an uncommon etiology of AI.
Observation:
- A 47-year-old woman presented with symptoms of AI, including weight loss and nausea.
- Cerebrospinal fluid analysis revealed Cryptococcus, and CT imaging showed bilateral adrenal gland enlargement.
- The patient was treated with amphotericin B and glucocorticoids, with initial clinical improvement.
Findings:
- Long-term follow-up revealed persistently enlarged adrenal glands and positive cryptococcus antigen.
- Low IgG levels were also noted, suggesting ongoing immunocompromised status.
- Literature review indicated a lack of long-term follow-up data for AI caused by disseminated cryptococcosis.
Implications:
- Patients with AI due to disseminated fungal infections require extended monitoring for adrenal gland resolution.
- Ongoing assessment of immunocompromised status is essential for managing these patients.
- This case underscores the importance of considering fungal infections in the differential diagnosis of AI.
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