TUBERCULOSIS AND ADRENAL INSUFFICIENCY: THE DUO CONTINUES TO REVEAL SECRETS

Introduction: Isolated adrenal tuberculosis is rare, particularly in countries where tuberculosis remains endemic. The advent of modern imaging has made it possible to identify atypical radiological forms that can mimic tumour lesions. This clinical case illustrates the importance of a complete aetiological investigation in all cases of bilateral adrenal involvement, particularly in countries where tuberculosis is endemic. Case study: A 75-year-old patient with no history of tuberculosis presented with symptoms of adrenal insufficiency that had been developing over a period of six months. Clinical examination revealed an asthenic, hypotensive patient with no melanoderma. Laboratory tests confirmed primary adrenal insufficiency with an 8-hour cortisol level of 52 ug/l (normal range 62 to 194 ug/dL), adrenocorticotropic hormone (ACTH) of 148 pg/ml (normal range 9-60 pg/ml), hyponatraemia of 130 mmol/l and hyperkalaemia of 7.8 mmol/l. Adrenal computed tomography (CT) revealed atypical radiological features combining nodular, calcified and pseudotumoral lesions. The diagnosis was confirmed by bacteriological testing. Treatment with hydrocortisone and anti-tuberculosis drugs led to an improvement in symptoms.