Primary adrenal failure of tuberculous aetiology and vitamin D deficiency
Dimitris Stefanopoulos, Ifigenia Kostoglou-Athanassiou, Aikaterini Michou, Aikaterini Chronaiou, Razvan Alexandros Badila, Nicolaos Klonaris, Olympia Karagianni & Areti Karfi
Primary adrenal failure may be of autoimmune or infectious aetiology, tuberculosis being a well known cause. In tuberculosis vitamin D deficiency has been described, while vitamin D sufficiency has been reported to be necessary for the mounting of an efficient immune response to the mycobacterium.
The aim was to describe the case of a patient with primary adrenal failure of tuberculous aetiology and severe vitamin D deficiency.
A female patient, aged 74 years, presented with weakness, nausea and hypotension. Abnormally low blood cortisol levels were measured. Hydrocortisone was administered for the management of the acute syndrome and the patient improved. A Mantoux test was intensely positive despite the administration of large hydrocortisone doses. During laboratory investigations abnormally low calcium and phosphorus levels were measured. Further tests revealed low vitamin D levels, 25(OH)D3 being 4 ng/ml and secondary hyperparathyroidism. Vitamin D was administered for the repletion of vitamin D deficiency. The patient also had hyperthyroidism caused by autonomous multinodular goiter and antithyroid drugs were administered, resulting in the remission of hyperthyroidism. Consequently, antituberculous therapy was initiated, and symptoms such as cough were cured and the patient was given long term substitution therapy with hydrocortisone.
Conclusion: The case of a patient with primary adrenal failure of tuberculous aetiology is described. The patient also had severe vitamin D deficiency. It appears that vitamin D deficiency may exist in patients with tuberculosis. Vitamin D sufficiency may be necessary for the effective eradication of tuberculosis in an affected patient.