A Case Of Addison’s Due To Non Meningococcal (Tuberculous) Adrenal Hemorrhage

Abstract

A 40 year old male patient was admitted with history of nausea, vomiting, loss of appetite, loss of weight and severe fatigue with past history of tuberculosis and had ATT for 6 months. Findings in physical examination were mild dehydration, hyper pigmentation of face, hands (creases), elbows and feet, and low blood pressure. Lab evaluation was normal except for raised ESR. Biochemical workup showed hyponatremia, hyperkalemia , and raised Creatinine. Ultrasound of abdomen showed bilateral enlarged adrenals with calcifications, and also thickened ileocaecal junction noted. CT scan of abdomen showed bilateral enlarged adrenals with small hemorrhages and speckled calcification. Endocrinal assays showed low early morning serum cortisol and high adrenocorticotropic hormone (ACTH). History, clinical examination, laboratory work up confirmed the diagnosis of Addison's disease secondary to tuberculosis. Patient was kept on cortisol supplementation along with antituberculosistreatment(ATT). Bilateral adrenal hemorrhage is a rare complication of tuberculosis which was documented in our case but calcifications in adrenal glands are common finding in tuberculosis.