Endocrine Abstracts

Introduction: Tuberculosis is an insidious disease and may be diagnosed after it afected many organs.

Case presentation: We present the case of a 56 years old female, who followed antituberculosis treatment in 2003 for pulmonary tuberculosis and during the treatment developed acute renal failure and for this reason the treatment was stopped. During the evaluations a left kidney tumor was detected. Left nephrectomy was performed in 2003 (HP examination – angiomyolipoma), and left suprarenalectomy in 2003 for CSR non-secretive adenoma. In March 2007 she was diagnosed with a non-secretive adrenal tumor of 3/2/2.5 cm at the level of right adrenal gland. The patient was evaluated by PET with FDG imaging in August 2008, which raised suspicion of malignancy, and afterwards a transcutaneous biopsy was performed which showed areas of necrosis. In January 2010 the patient developed adrenal insufficiency. Because the adrenal tumor formation was in dimensional evolution, the PET examination and biopsy raised suspicion of malignancy and the patient developed adrenal insufficiency, surgery was decided. Intervention by laparoscopy was performed and an intensive process of left supra and inframezocolic perivisceritis was outlined. The adrenal gland with a volume enlarged to 10/8 cm presented an 8/2 cm tumor, hard, whitish, heterogeneous across the section, without invasion of adjacent structures. Histopatologic examination was suggestive for adrenal tuberculosis. Consequently, the previous histological pieces were reassessed and the conclusion was of tuberculosis with multiple determinations: adrenal (bilateral), peritoneal and retroperitoneal. Antituberculosis treatment was decided, the patient having a favorable evolution. Unfortunately, the diagnostis was performed after many years of tuberculosis evolution.

Conclusions: Tuberculosis remains a common cause of adrenal failure especially in patients who have not followed full treatment. Histopathological evaluation is very important for correct diagnosis in order to determine therapeutical aproach and the subsequent evolution and prognosis of these patients.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.