Background: Fungal infections are a rare cause of primary adrenal insufficiency, raising difficulties in the diagnostic and therapeutic approaches.
Case report: A 56 years old diabetic male, who lived in Guinea in 1968, was referred to our inpatients clinic because of a 7,7x3 cm adrenal incidentaloma. He presented with hyperpigmentation, postural symptoms, weakness, fatigue, anorexia and weight loss.
The rapid ACTH stimulation test had a subnormal response and ACTH was
1144 pg/ml. The screening for pheochromocytoma was negative.
He was submitted to left adrenal resection. The other gland had no macroscopic evidence of tumours.
The histological exam identified a fungal agent, Hystoplasma capsulatum.
He is under treatment with Hidrocortisone, Fluodrocortisone and Itraconazole.
Comments: This is a rare cause of Addisons`disease. However, as tuberculosis became less frequent, fungal disease is a more common cause of adrenal gland infection, particularly if the patient lives in an endemic area. The accurate diagnosis has implications in therapeutic approach.