A case of tuberculous epididymitis associated with Addison's disease

A 68-year-old man was admitted to the hospital because of loss of appetite, easy fatigability, and skin pigmentation. Physical examination revealed that the bilateral epididymides were enlarged and hard without tenderness. At 7 a.m., the basal cortisol level in the plasma was 22.4 ng/ml and ACTH 318 pg/ml. The clinical diagnosis was Addison's disease. Biopsy of the right epididymis revealed evidence of active tuberculosis. Hydrocortisone (18 mg/day) and anti-tuberculous drugs were administered, and the patient became well and regained his appetite in a week. In this case, laparotomy was not performed, but all clinical findings and the course indicated that adrenal tuberculosis was the most likely cause of Addison's disease. CT scanning of the adrenal region demonstrated large, bilateral, homogeneous, low density, and non-enhancing mass. This is the first report dealing with CT findings of Addison's disease with tuberculous epididymitis.