Addison’s disease due to tuberculosis of the adrenal glands – case report and review of the literature

Abstract

Introduction. Addison’s disease (AD) or primary adrenocortical insufficiency was first described by Thomas Addison in patients with adrenal tuberculosis (TBC). Over the past several decades, along with the introduction of antituberculous chemotherapy, the incidence of TBC and AD have declined. The most common symptoms are nonspecific, therefore diagnosis is often delayed and patients may first present with a life-threatening crisis. In this report we present a case of newly diagnosed Addison's disease due to tuberculosis of the lungs and both adrenal glands, endured many years ago, with a life-threatening crisis in the past history.

Case report. A 75-year-old man was admitted to our hospital because of weakness, nausea, lack of appetite, low blood pressure, postural hypotension and electrolyte disturbances. The first symptoms appeared 20 years ago; at that time he had been cured because of lung tuberculosis. One month before he was admitted to Department of Endocrinology, he had had an episode of cardiac arrest during attempt of laparoscopic cholecystectomy. The diagnosis towards Addison's disease has been made. Based on the past history of TBC, clinical symptoms, laboratory results and CT features we could confirm an initial diagnosis of primary adrenocortical failure due to tuberculosis of the adrenal glands. As a result of applied replacement therapy, we gained improvement of patient's condition.

Conclusion. Although tuberculous Addison’s disease has been decreasing markedly in recent years, the possibility of adrenal insufficiency should be considered when weight loss, gastrointestinal symptoms, hyponatraemia and hyperkalaemia are observed in patients with active tuberculosis or in those having a past history of TBC.