Adrenal insufficiency with enlarged adrenals

Abstract

Five patients with adrenal insufficiency and large adrenal glands at presentation are reported. Addison's disease was due to adrenal tuberculosis in three patients, with important changes in adrenal configuration on CT reflecting the natural history of the disease. Adrenal infiltration by non-Hodgkin lymphoma and metastatic carcinoma of the lung was the cause of the disease in the fourth and fifth patients, respectively, who developed signs of adrenal insufficiency before the diagnosis of the primary lesion became apparent. Histologic confirmation was established after unilateral adrenalectomy in three patients. In two patients with adrenal tuberculosis, long clinical and laboratory follow-up confirmed the diagnosis. This report indicates that Addison's disease is not infrequently associated with adrenal enlargement. Adrenal size is related to the cause and duration of the various disease states leading to adrenal insufficiency. Moreover, adrenal insufficiency associated with enlarged adrenal glands can be the presenting manifestation of lymphoma or metastasis.

Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT

“…On CT images, the involved adrenal glands are usually enlarged, which could be misdiagnosed as primary adrenal tumor. Although previous reports have described the CT features of adrenal tuberculosis, most of these studies were case reports with plain CT scans [2][3][4][5]. To the best of our knowledge, no study has analyzed the specific imaging criteria for differentiating tuberculosis from primary tumors in the adrenal glands.…”

Pseudotumoral Adrenal Tuberculosis

“…Pathologic studies of the adrenals glands infected by tuberculous mycobacterium revealed caseous necrosis area and tuberculous granuloma at an early stage which causes destruction of the adrenal cortex leading to fibrosis and calcification (Efremidis et al, 1996).…”

Primary Adrenal Tuberculosis: Role of Computed Tomography and CT-Guided Biopsy in Diagnosis

“…Extrapulmonary occurrence of TB is estimated up to 15% [2] and endocrine glands are involved in 0.03% of extrapulmonary TB cases [4] . To the best of our knowledge, this rare pathological entity of adrenal insuffi ciency due to isolated adrenal TB is encountered in no more than six reports in the literature [1,[4][5][6][7][8] .…”

“…The central hypoattenuating values represent areas of caseous necrosis [9] . In response to anti-TB therapy, the glands become gradually atrophic with irregular margins and usually develop calcifi cations (both appearing at least after 1 year of initiation of treatment) [5,9] .…”