Primary adrenal insufficiency in isolated cryptococcosis of the adrenal gland: CT and MR imaging appearances

Cheng, Hua-Ming; Chou, Andy Shau-Bin; Chiang, Kuo-Hsien; Huang, Hsin-Wen; Chang, Pau-Yang; Yen, Pao-Sheng

doi:10.1016/j.ejrex.2010.06.006

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…These primary adrenal insufficiency symptoms include fatigue, anorexia, hypotension, hyperkalemia, hyponatremia, skin hyperpigmentation, and hypoglycemia, with sudden death also possibly being a presenting symptom [ 17 , 18 , 19 ]. In previous reports [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], adrenal gland involvement of cryptococci has been typically associated with disseminated disease, with CNS, or lung infections [ 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 32 , 33 , 36 , 37 ], but several exceptions exist in the literature (for complete list of previous cases with adrenal gland involvement see Table S2 [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 3...…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], adrenal gland involvement of cryptococci has been typically associated with disseminated disease, with CNS, or lung infections [ 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 32 , 33 , 36 , 37 ], but several exceptions exist in the literature (for complete list of previous cases with adrenal gland involvement see Table S2 [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ])....…”

Section: Discussionmentioning

confidence: 99%

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Diffuse Adrenal Gland and Pancreas Necrosis in a Patient with Disseminated Cryptococcosis—Case Report

Wappler-Guzzetta

Gray

Dagostino

et al. 2022

Life

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(1) Background: Cryptococcus neoformans is mostly known for causing meningitis, with or without disseminated disease. (2) Case presentation: An immunocompromised 75-year-old gentleman presented post renal transplant with generalized weakness, altered mental status, hypoxemia, and hyponatremia, and was found to have disseminated cryptococcal infection. After an initial improvement, the patient became suddenly hypotensive, and passed away soon after. The autopsy revealed widespread cryptococcal involvement, with the most severely affected organs being the brain, lungs, pancreas, adrenal glands, and spleen. The pancreas and one of the adrenal glands revealed diffuse granulomatous cryptococcal infection, with large areas of necrosis. The spleen also showed a large area of cryptococcal necrosis. In addition, the patient had chylous ascites, without histologically identifiable organisms. (3) Conclusions: This is a rare case of disseminated cryptococcal infection with severe necrotizing adrenalitis and pancreatitis, in addition to significant spleen, lung, and central nervous system involvement. The early recognition and treatment of the adrenal gland and pancreas cryptococcosis with surgical interventions may lead to better outcomes in affected patients. Furthermore, steroid treatment and diabetes mellitus may be risk factors for adrenal gland involvement. Additionally, clinicians should keep cryptococcal infection in their differential diagnosis for isolated adrenal gland and pancreas lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diffuse Adrenal Gland and Pancreas Necrosis in a Patient with Disseminated Cryptococcosis—Case Report

Wappler-Guzzetta

Gray

Dagostino

et al. 2022

Life

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“…Although the adrenal glands are able to be involved in disseminated cryptococcosis, adrenal insufficiency caused by this fungus is uncommon [ 14 ]. In previous reports, most cases of adrenal insufficiency caused by cryptococcosis were accompanied by meningoencephalitis [ 9 , 15 - 20 ]. There are only two previous reports describing patients with isolated adrenal cryptococcosis without meningoencephalitis [ 9 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports, most cases of adrenal insufficiency caused by cryptococcosis were accompanied by meningoencephalitis [ 9 , 15 - 20 ]. There are only two previous reports describing patients with isolated adrenal cryptococcosis without meningoencephalitis [ 9 , 20 ]. To the best of our knowledge, this is the first report of cryptococcosis of the bilateral adrenal glands and liver without meningoencephalitis.…”

Section: Discussionmentioning

confidence: 99%

Successful management of cryptococcosis of the bilateral adrenal glands and liver by unilateral adrenalectomy with antifungal agents: a case report

et al. 2011

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BackgroundCryptococcus species usually affect the central nervous system and lungs in immunocompromised hosts. Although the adrenal glands can be involved in disseminated cryptococcosis, primary adrenal insufficiency caused by the fungal infection is uncommon.Case presentationWe present a case of primary adrenal insufficiency with bilateral adrenal masses and liver invasion in a 43-year-old man with mild type 2 diabetes mellitus. Cryptococcosis was diagnosed by fine-needle aspiration biopsy of the liver mass. The serum cryptococcal antigen titer was elevated to 1:256. After 6 months of antifungal therapy with fluconazole and amphotericin B, the size of the liver mass was decreased, but no significant changes were observed in the bilateral adrenal masses and the serum cryptococcal antigen titer remained elevated at 1:128. To control the cryptococcosis, a laparoscopic left adrenalectomy was performed, followed by antifungal therapy. After the unilateral adrenalectomy, the size of the remaining right adrenal mass was reduced and the serum cryptococcal antigen titer declined to 1:4.ConclusionsThis is the first report describing adrenal cryptococcosis with adrenal insufficiency and liver invasion without central nervous system involvement. Adrenal cryptococcosis should be considered in the differential diagnosis for patients with bilateral adrenal masses with primary adrenal deficiency. Unilateral adrenalectomy was quite effective in controlling the cryptococcosis in this case. Even in patients with bilateral adrenal cryptococcosis, unilateral adrenalectomy should be an option for treatment of disseminated cryptococcosis.

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Hypercalcaemia associated with disseminated cryptococcosis

Aziz

Adam

2021

BMJ Case Rep

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We report an elderly man who presented with giddiness and right-sided weakness, constipation and constitutional symptoms for 6 months duration. Blood investigations indicated hypercalcaemia with normal serum phosphate and acute kidney injury. Serum intact parathyroid hormone was suppressed. CT revealed bilateral tiny lung nodules with right upper lobe tree in bud appearance and incidental findings of bilateral adrenal lesion. Tuberculosis was ruled out. CT adrenal showed multiseptated hypodense rim enhancement adrenal lesion bilaterally. Adrenal function tests were normal except for low dehydroepiandrosterone (DHEA). Right-sided cervical lymph node biopsy confirmed fungal infection with the presence of intracellular and extracellular fungal yeast. Serum cryptococcus antigen titre was positive. Our final diagnosis was disseminated cryptococcosis with lungs, bilateral adrenal gland and lymph nodes involvement. The patient was then treated with antifungal treatment. Serum calcium was normalised after 1 month with marked clinical improvement.

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Primary adrenal insufficiency in isolated cryptococcosis of the adrenal gland: CT and MR imaging appearances

Cited by 4 publications

References 9 publications

Diffuse Adrenal Gland and Pancreas Necrosis in a Patient with Disseminated Cryptococcosis—Case Report

Diffuse Adrenal Gland and Pancreas Necrosis in a Patient with Disseminated Cryptococcosis—Case Report

Successful management of cryptococcosis of the bilateral adrenal glands and liver by unilateral adrenalectomy with antifungal agents: a case report

Hypercalcaemia associated with disseminated cryptococcosis

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