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Tuberculous Addison’s disease with increased hydrocortisone requirements due to administration of rifampicin
  1. Kazuhisa Kusuki,
  2. Satoshi Watanabe and
  3. Yuzo Mizuno
  1. Metabolism and Endocrinology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
  1. Correspondence to Dr Kazuhisa Kusuki, kusuki.k{at}


A 58-year-old man was referred to our hospital for darkened skin, general fatigue and weight loss. His adrenocorticotropic hormone and cortisol levels indicated a primary adrenal insufficiency. 18Fluorodeoxyglucose positron emission tomography/CT showed bilateral enlargement of the adrenal glands, with 18fluorodeoxyglucose accumulation. Loop-mediated isothermal amplification assays of bronchoalveolar lavage fluid were positive for Mycobacterium tuberculosis. The patient was diagnosed with tuberculous Addison’s disease and treated with antituberculosis agents, including rifampicin. The patient’s fatigue worsened gradually after initiation of rifampicin, and the dosage of hydrocortisone was increased. Serum cortisol level monitoring at 2 hours after administration of hydrocortisone was shown to be clinically useful for determining the optimal dose, especially with concurrent use of rifampicin.

  • TB and other respiratory infections
  • adrenal disorders
  • drug interactions

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  • Contributors KK was the patient’s doctor and had a central role in writing this manuscript. SW and YM also engaged in patient care and wrote this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.