Addisons disease (primary adrenal cortical failure) is the lack of glucocorticoids due to disease of the adrenal gland. At 1855, when Addison described it tuberculosis (TB) was the main etiology. May be we are coming to that time. TB is an infectious disease caused by Mycobacterium tuberculosis. The most commonly (third of the patients) affects the lungs, as well as the other organs. Symptoms of the disease are non specific and are deteriorating slowly, so the disease is often overlooked, or not recognized until comes to infection or another stressful situation of the body.
51-year old women with a functional right kidney, after cholecystectomy was first time admitted in the hospital due to the upper urinary tract infections and renal failure. She was treated with ciprofloxacin. Then she suffered from severe headache, nausea and vomiting. She passed lumbar puncture. Cerebrospinal fluid exam was typical for serous lymphocytic meningitis. At the same time mild hyperkalemia (6.0 mmol/L) and hyponatremia (132 mmol/L) were diagnosed and treated symptomatically. In the next two months she felt worse, lose about 30 kg. The laboratory exams confirmed the failure of the adrenals.
The clinical signs were masked because the women is the Roma ethnicity and with hyperpigmented skin. We found even primary hypothyroidism. The treatment with hydrocortisone and levotiroxine started. The abdominal CT-scan showed small adrenals with microcalcinations. We preformed US-guided fine needle aspiration (FNA) biopsy of the adrenals, because the other tests for TB were negative. The PCR diagnostics for TB in the FNA biopsy sample was positive and confirmed suspected adrenal TB. She started with treatment for TB.
TB is becoming one of the infections of the developed world we have to think about, because of the migrations.