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Submitted: 21 July 2016 Modified: 22 July 2016
HERDIN Record #: NCR-JAFES-16072115544750

Acute adrenal insufficiency as the primary manifestation of extrapulmonary tuberculosis: A case report.

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Acute adrenal insufficiency (AI) is a life-threatening condition. While Addison's disease (AD) is rare, in developing countries, tuberculosis (TB) still remains as the primary cause in 7 to 20% of cases. Urinary TB is also the third most common form of extrapulmonary disease. We report a case of 37-year-old male who presented with weakness, anorexia, weight loss, dysuria, flank pain and low grade fever. Examination revealed hypotension, hyperpigmentation, hyponatremia, hypoglycemia and low serum cortisol. He was diagnosed to have adrenal crisis due to Addison's disease and extrapulmonary TB manifesting as urinary tract infection (UTI). He was treated with corticosteroids and anti-TB medications. Urologic reconstructive surgery was subsequently planned.

Publication Type
Publication Sub Type
Case report
Journal of the ASEAN Federation of Endocrine Societies
Publication Date
May 2016
LocationLocation CodeAvailable FormatAvailability (632) 6373162 Fulltext External Link (View)
1. Addison, T . "On the constitutional and local effects of disease of the supra-renal capsules" Medical History 13(2): 195-202, 1969. Retrieved from:
2. Patnaik, M M, Deshpande, A K. "Diagnosis –Addison’s disease secondary to tuberculosis of the adrenal glands" Clin Med Res 6(1): 29, 2008. Retrieved from:
3. Brooke, A M, Monson, J P. "Addison’s disease" Medicine 37(8): 416-9, 2009. Retrieved from:
4. Guttman, P H. " Addison’s disease: A statistical analysis of 566 cases and study of the pathology" Arch Path 10, 742-85, 1930
5. Kinjo, T , Higuchi, D , Oshiro, Y , Nakamatsu, Y , Fujita, K , Nakamoto, K . "Addison’s disease due to tuberculosis that required differentiation from SIADH" J Infect Chemother 15(4): 239-42, 2009. Retrieved from:
6. Lam, K Y, Lo, C Y. "A critical examination of adrenal tuberculosis and a 28-year autopsy" Clin Endocrinol (Oxf) 54(5): 633-9, 2001. Retrieved from: http://10.1046/j.1365-2265.2001.01266.x
7. Ma, E S, Yang, Z G, Li, Y , Guo, K Y, Deng, Y P, Zhang, . "Tuberculous Addison’s disease: Morphological and quantitative evaluation with multidetector-row CT" Eur J Radiol 62(3): 352-8, 2007. Retrieved from:
8. Yokoyama, T , Toda, R , Kimura, Y , Mikagi, M , Aizawa, H . "Addison’s disease induced by miliary tuberculosis and the administration of rifampicin" Inter Med 48(15): 1297-300, 2009. Retrieved from:
9. Zhang, X C, Yang, Z G, Li, Y , Min, P Q, Guo, Y K, Deng, Y P. "ddison’s disease due to adrenal tuberculosis: MRI features" Abdom Imaging 33(6): 689-94, 2008. Retrieved from:
10. Nomura, K , Demura, H , Saruta, T . "Addison’s disease in Japan: Characteristics and changes revealed in a nationwide survey" Intern Med 33(10): 602-6, 1994. Retrieved from:
11. Bhatia, E , Jain, S K, Gupta, R K, Pandey, R . "Tuberculous Addison’s disease: Lack of normalization of adrenocortical function after anti-tuberculous chemotherapy" Clin Endocrinol (Oxf) 48(3): 355-9, 1998. Retrieved from:
12. Guo, Y K, Yang, Z G, Li, Y , Ma, E S, Deng, Y P, Min, P Q. "ddison’s disease due to adrenal tuberculosis: Contrast-enhanced features and clinical duration correlation" Eur J Radiol 62(1): 126-31, 2007. Retrieved from:
13. Rowińska-Zakrzewska, E , Szopiński , J , Remiszewski, P , Szymański , D , Miller, P , Pawlicka, L . "Tuberculosis in the autopsy material: Analysis of 1500 autopsies performed between 1972 and 1991 in the Institute of Tuberculosis and Chest Diseases, Warsaw, Poland" Tuber Lung Dis 76(4): 349-54, 1995. Retrieved from:
14. Soule, S . "Addison’s disease in Africa- A teaching hospital experience" Clin Endocrinol (Oxf) 50(1): 115-20, 1999. Retrieved from:
15. Jacobi , J , Schnellhardt, S , Kulschewski, A , Amann, K U, Kuefner, M A, Eckardt, K U. "An unusual case of hyponatraemia" Nephrol Dial Transplant 25(3): 998-1001, 2010. Retrieved from:
16. Dorin, R I, Qualls, C R, Crapo, L M. "Diagnosis of adrenal insufficiency" Ann Intern Med 139(3): 194-204, 2003. Retrieved from:
17. Upadhyay, J , Sudhindra, P , Abraham, G , Trivedi, N . "Tuberculosis of the adrenal gland: A case report and review of the literature of infections of the adrenal glands" Int J Endocrinol 2014, 876037, 2014
18. Wise, G J, Marella, V K. "Genitourinary manifestations of tuberculosis" Urol Clin North Am 30(1): 111-21, 2003
19. Kelestimur, F . "Recovery of adrenocortical function following treatment of tuberculous Addison’s disease" Postgrad Med J 69(816): 832-4, 1993. Retrieved from:
20. Visweswaran, R K, Bhat, S , Bhat, S . Tuberculosis of the urinary tract. In: Comprehensive Clinical Nephrology. J Floege, RJ Johnson, J Feehally, eds St. Louis: Elsevier Saunders, 2010. (4th ed)
21. Dąbrowska, A , Tarach, J , Prystupa, A , Kurowska, M . "Addison’s disease due to tuberculosis of the adrenal glands" Journal of Pre-Clin Clin Res 6(2): 88-92, 2012
22. Bancos, I , Hahner, S , Tomlinson, J , Arlt, W . "Diagnosis and management of adrenal insufficiency" Lancet Diabetes Endocrinol 3(3): 216-26, 2015. Retrieved from:

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