Primary Adrenal Tuberculosis Presenting with Diffuse Hyperpigmentation: A Rare Case Report
Adrenal Tuberculosis
Keywords:
Adrenal Tuberculosis, Addison’s disease, hyper pigmentation, serum cortisol
Abstract
Adrenal tuberculosis is almost always secondary to tuberculosis elsewhere in the body. Primary adrenal tuberculosis is extremely rare. We report a rare case of a 42 year old man who presented with hyper pigmentation of skin all over the body. Patient was diagnosed with Addison’s disease caused by adrenal gland tuberculosis. There was no evidence of active tuberculosis elsewhere in the body. It is difficult to diagnose adrenal tuberculosis in routine TB related examinations as the signs and symptoms of adrenal tuberculosis are nonspecific and moreover signs and symptoms of adrenal insufficiency do not occur until more than 90% of the gland is destroyed. We diagnosed the case with the help of lab tests for adrenal function, CT scan and FNAC of the gland. Patient improved with anti-tubercular treatment. We have reviewed the current literature of adrenal TB also so that it can be diagnosed and treated before extensive damage to the adrenal gland.
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References
1. Addison T. On the constitutional and Local Effects of Disease of the Suprarenal Capsules. Highley London 1855
2. Nomura K, Demura H, Saruta T. Addison’s disease in Japan: characteristics and changes revealed in a nationwide survey. Intern Med 1994; 33: 602
3. Laway BA, Khan I, Shah BA, Choh NA, Bhat MA, Shah ZA. Pattern of adrenal morphology and function in pulmonary tuberculosis: response to treatment with anti-tubercular therapy. Clin Endocrinol (Oxf) 2013;79(03):321–325
4. Brooke A M, Monson JP. Addison’s disease. Medicine (Baltimore) 2009; 37(08):416–419.
5. Stuti Gupta, Md Abu Masud Ansari, Arun Kumar Gupta, Poras Chaudhary, Lalit Kumar Bansal, Current Approach for Diagnosis and Treatment of Adrenal Tuberculosis Our Experience and Review of Literature. The Surgery Journal 2022. Vol. 8 No: 1: 92-97
6. Guttman PH, Addison’s disease. A statistical analysis of five hundred and sixty six cases and a stydy of the pathology. Arch Pathol 1930; 10: 742
7. K Y Lam, C Y Lo. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of acute tuberculosis. Clinical Endocrinology 2001; 54 (5): 633-639
8. Patnaik MM, Deshpande AK. Diagnosis–Addison’s disease secondary to tuberculosis of the adrenal glands. Clin Med Res 2008;6 (01):29
9. Laureti S, Aubourg P, Calcinaro F, et al. Etiological diagnosis of primary adrenal insufficiency using an original flowchart of immune and biochemical markers. J Clin Endocrinol Metab 1998; 83:L 3163
10. Vita JA, Silverberg SJ, Goland RS, et.al. Clinical clues to the cause of Addison’s disease. Am J Med 1985; 78: 461
11. Sun ZH, Nomura K, Toraya S, et.al. Clinical Significance of adrenal computed tomography in Addison’s disease. Endocrino Jpn 1992; 39: 563
12. Villabona CM, Sahun M, Ricart W, et.al. Tuberculous Addison’s disease. Utility of CT in diagnosis and follow up. Eur J Radiol 1993; 17: 210.
13. Guo YK, Yang ZG, Li Y, et.al. Addison’s disease due to adrenal tuberculosis: contrast -enhanced CT features and clinical duration correlation. Eur J Radiol 2007; 62: 126.
14. Gulmez I, Kelestimur F, Durak AC, Ozesmi M. Changes in the size of adrenal glands in acute pulmonary tuberculosis with therapy. Endocr J 1996; 43: 573.
15. Jagiriti Upadhyay, Praveen Sidhindra, George Abraham, Nitin Trivedi. Tuberculosis of the adrenal gland: A case report and review of the literature of infections of adrenal gland.Int J Endocrinol 2014;11: 1-7
16. F Kelistimur. The endocrinology of adrenal tuberculosis. The effects of the tuberculosis on the hypothalamo-pituitary-adrenocortical function. Journal of endocrinological investigation 2004; 27 (4): 380-386.
17. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficien cy. Lancet 2014; 383 (9935): 2152–2167.
18. Erickson QL, Faleski EJ, Koops MK, et al. Addison’s disease: the potentially life-threatening Tan. Cutis 2000; 66: 72-74
19. Stewart PM, Krone NP. Kroneburg HM, et al. Williums Text Book of Endocrinology, 12th ed. Philadelphia PA: Saunders Elsevier; 2011, pp 515-20
20. Lanza A, Heulfe I, Perillo L, Dell’Ermo A, Cirillo N. Oral manifestation as a sign of Addision’s disease: Abreief reappraisal, Open Dermatol J 2009; 3: 3-6.
21. Yu Huang, Yawei Zhang, Haifeng Wang, Nan Zhang. Primary bilateral adrenal tuberculosis with Addison’s disease: A case report. Urology Case Reports 2024; 56:1-3
22. F. Kelestimur, Y. Unlu, M.Ozesmi,andI.Tolu,“Ahormonaland radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis, ”Clinical Endocrinology 1994;. 41(1): .53–56.
23. Qiliang Teng, Bo Fan, Yutong Wang, et.al. Primary adrenal tuberculosis infection in patients with Behcet’s disease presenting as isolated adrenal metastasis by 18 F-FDG PET/CT: a rare case report and literature review. Gland Surg 2021; 10 (12): 3431-3442
24. B C Sarin, K Sibia, S Kukreja. Study of adrenal function in patients with tuberculosis. Indian J Tuberculosis 2018; 65 (3): 241-245.
25. Arlt W. The approach to the adult with newly diagnosed adrenal insufficiency. J ClinEndocrinol Metab 2009; 94 (4): 1059-1067
2. Nomura K, Demura H, Saruta T. Addison’s disease in Japan: characteristics and changes revealed in a nationwide survey. Intern Med 1994; 33: 602
3. Laway BA, Khan I, Shah BA, Choh NA, Bhat MA, Shah ZA. Pattern of adrenal morphology and function in pulmonary tuberculosis: response to treatment with anti-tubercular therapy. Clin Endocrinol (Oxf) 2013;79(03):321–325
4. Brooke A M, Monson JP. Addison’s disease. Medicine (Baltimore) 2009; 37(08):416–419.
5. Stuti Gupta, Md Abu Masud Ansari, Arun Kumar Gupta, Poras Chaudhary, Lalit Kumar Bansal, Current Approach for Diagnosis and Treatment of Adrenal Tuberculosis Our Experience and Review of Literature. The Surgery Journal 2022. Vol. 8 No: 1: 92-97
6. Guttman PH, Addison’s disease. A statistical analysis of five hundred and sixty six cases and a stydy of the pathology. Arch Pathol 1930; 10: 742
7. K Y Lam, C Y Lo. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of acute tuberculosis. Clinical Endocrinology 2001; 54 (5): 633-639
8. Patnaik MM, Deshpande AK. Diagnosis–Addison’s disease secondary to tuberculosis of the adrenal glands. Clin Med Res 2008;6 (01):29
9. Laureti S, Aubourg P, Calcinaro F, et al. Etiological diagnosis of primary adrenal insufficiency using an original flowchart of immune and biochemical markers. J Clin Endocrinol Metab 1998; 83:L 3163
10. Vita JA, Silverberg SJ, Goland RS, et.al. Clinical clues to the cause of Addison’s disease. Am J Med 1985; 78: 461
11. Sun ZH, Nomura K, Toraya S, et.al. Clinical Significance of adrenal computed tomography in Addison’s disease. Endocrino Jpn 1992; 39: 563
12. Villabona CM, Sahun M, Ricart W, et.al. Tuberculous Addison’s disease. Utility of CT in diagnosis and follow up. Eur J Radiol 1993; 17: 210.
13. Guo YK, Yang ZG, Li Y, et.al. Addison’s disease due to adrenal tuberculosis: contrast -enhanced CT features and clinical duration correlation. Eur J Radiol 2007; 62: 126.
14. Gulmez I, Kelestimur F, Durak AC, Ozesmi M. Changes in the size of adrenal glands in acute pulmonary tuberculosis with therapy. Endocr J 1996; 43: 573.
15. Jagiriti Upadhyay, Praveen Sidhindra, George Abraham, Nitin Trivedi. Tuberculosis of the adrenal gland: A case report and review of the literature of infections of adrenal gland.Int J Endocrinol 2014;11: 1-7
16. F Kelistimur. The endocrinology of adrenal tuberculosis. The effects of the tuberculosis on the hypothalamo-pituitary-adrenocortical function. Journal of endocrinological investigation 2004; 27 (4): 380-386.
17. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficien cy. Lancet 2014; 383 (9935): 2152–2167.
18. Erickson QL, Faleski EJ, Koops MK, et al. Addison’s disease: the potentially life-threatening Tan. Cutis 2000; 66: 72-74
19. Stewart PM, Krone NP. Kroneburg HM, et al. Williums Text Book of Endocrinology, 12th ed. Philadelphia PA: Saunders Elsevier; 2011, pp 515-20
20. Lanza A, Heulfe I, Perillo L, Dell’Ermo A, Cirillo N. Oral manifestation as a sign of Addision’s disease: Abreief reappraisal, Open Dermatol J 2009; 3: 3-6.
21. Yu Huang, Yawei Zhang, Haifeng Wang, Nan Zhang. Primary bilateral adrenal tuberculosis with Addison’s disease: A case report. Urology Case Reports 2024; 56:1-3
22. F. Kelestimur, Y. Unlu, M.Ozesmi,andI.Tolu,“Ahormonaland radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis, ”Clinical Endocrinology 1994;. 41(1): .53–56.
23. Qiliang Teng, Bo Fan, Yutong Wang, et.al. Primary adrenal tuberculosis infection in patients with Behcet’s disease presenting as isolated adrenal metastasis by 18 F-FDG PET/CT: a rare case report and literature review. Gland Surg 2021; 10 (12): 3431-3442
24. B C Sarin, K Sibia, S Kukreja. Study of adrenal function in patients with tuberculosis. Indian J Tuberculosis 2018; 65 (3): 241-245.
25. Arlt W. The approach to the adult with newly diagnosed adrenal insufficiency. J ClinEndocrinol Metab 2009; 94 (4): 1059-1067
Published
2025-12-09
How to Cite
1.
Zuber N, Zubair I, Ahmad S, Ahmad Z, Salar W. Primary Adrenal Tuberculosis Presenting with Diffuse Hyperpigmentation: A Rare Case Report. jms [Internet]. 2025Dec.9 [cited 2026Oct.3];28(4):42-6. Available from: https://www.jmsskims.org/index.php/jms/article/view/1442
Section
Case Reports
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