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Rare disease
CASE REPORT
Tuberculosis as a differential for bilateral adrenal masses in the UK
  1. Maulee Arambewela1,2,
  2. Richard Ross1,3,
  3. Omar Pirzada4 and
  4. Sabapathy P Balasubramanian5,6
  1. 1 Endocrinology Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Department of Physiology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
  3. 3 Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
  4. 4 Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  5. 5 Department of Surgical Oncology, University of Sheffield, Sheffield, UK
  6. 6 Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Mr Sabapathy P Balasubramanian, s.p.balasubramanian{at}sheffield.ac.uk

Abstract

Primary adrenal insufficiency (PAI) is a potentially fatal disease. Adrenal tuberculosis(TB) causing PAI is rare in the developed world. We present a seemingly well, 78-year-old Caucasianwoman in the UK who developed adrenal crisis following elective hip surgery. Biochemical tests confirmed PAI and steroid replacement was initiated. Imaging of the abdomen demonstrated bilateral adrenal masses and a fluorodeoxyglucose positron emission tomography (FDG-PET) scan showed increased uptake in both adrenals suggestive of malignancy. Following a retroperitoneoscopic left adrenalectomy, histology showed caseating necrosis with xanthogranulomatous inflammation favouring a diagnosis of TB. She was commenced on anti-TB treatment. Diagnosing adrenal TB in the west can be challenging especially in the absence of extra-adrenal TB. FDG-PET scans can be falsely positive in presence of chronic active inflammatory conditions, such as TB, and a tissue diagnosis is required. It is important that clinicians remain vigilant of this important disease, which can masquerade as malignancy.

  • infections
  • adrenal disorders
  • TB and other respiratory infections

https://doi.org/10.1136/bcr-2018-228532

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    Footnotes

    • Contributors MA: acquisition of data and images, planning of the draft and writing the manuscript. RR: literature review, planning and finalising the draft. OP: literature review, planning and finalising the manuscript. SPB: acquisition of data, planning and finalising the 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.