Endocrine Abstracts

JOINT3684

Introduction: Adrenal tuberculosis is rare, accounting for between 3% and 9% of the etiologies of adrenal insufficiency (AI). It is responsible of acute or chronic adrenal insufficiency. Our case illustrates an unusual presentation of adrenal tuberculosis whose ultimate aim is to make our medical community aware of the various aspects of this widespread condition in the Moroccan context.

Case: A 43-year-old patient with a history of chronic smoking and cured hepatitis B presented with diffuse abdominal pain. presented with diffuse abdominal pain with no other associated digestive signs. Questioning revealed weight loss of 8 kg in 2 months, associated with progressive melanoderma. Abdominal computed tomography revealed a necrotic pseudo adrenal mass measuring approximately 63x35x75 mm. Chronic adrenal insufficiency was based on a low cortisol level of 5.2ng/dl. The patient was started on hydrocortisone replacement therapy and referred for surgery due to the “suspicious” nature of the adrenal mass. The patient was referred to us from the pre-anaesthesia consultation for preoperative endocrinological evaluation. The clinico-biological data were in favour of a peripheral AI. The etiological investigation, notably the Quantiferon test, was very positive at 10 UI/ml. X-ray was normal. The diagnosis of adrenal tuberculosis was in consultation with the pneumo-phtisiologists, was based on a combination of radiological (appearance suggestive of a bacillary cause), clinical (signs of tuberculosis of tuberculosis impregnation) and biological (very positive quantiferon). The patient was put hormone replacement therapy with hydrocortisone, combined with antituberculosis antituberculosis treatment.

Discussion: The adrenal localization of tuberculosis occurs via the hematogenous route from the CT scan and biopsy play a vital role in the diagnosis. Adrenal tuberculosis, a rare cause of AI in the literature, is discovered late in the course of infection, with pathognomonic signs are adrenal calcifications, testifying to the chronicity of the condition. Anti-tuberculosis treatment can lead to partial recovery of steroidogenesis. Our patient’s clinical course looks very satisfactory, pending sufficient time for radiological control.

Our case: • Reports an AI during the active, progressive phase of adrenal tuberculosis, in contrast to cases often reported in the chronic phase.• Unusual tumor-like radiological findings, which may lead to surgical intervention.• Underlines the importance of multidisciplinary care and the need to respect the sphere of specialized skills.