Addison’s disease due to adrenal tuberculosis: MRI features

Abstract

Findings of adrenal tuberculosis with MR scanning have never been reported in the literature. The aim of this study was to determine MR characteristics for tuberculous Addison's disease, and evaluate the utility of MR imaging as a useful diagnosis tool of the entity. Eighteen patients with proven adrenal tuberculosis were included. All patients had conventional T(1)- and T(2)-weighted image. Among the 18 patients, contrast-enhanced T(1)WI had been done in 10. MR manifestations were retrospectively evaluated blindly for the location, contour, signal intensity, and enhancement patterns. All patients clinically exhibited hyperpigmentation and lethargy. Physical examination revealed weight loss, signs of dehydration, and hypotension. Biochemical investigation confirmed adrenal insufficiency. The adrenal glands were affected bilaterally in 16 patients (89%) and unilaterally in 2 patients (11%). Thirty-three glands were enlarged (97%), while one was atrophic (3%). Of the 33 enlarged glands, 20 (61%) were mass-like and 13 (39%) had preserved contours. The central region of the enlarged glands demonstrated T(2) hypo- or iso-SI in 21 (62%) and T(2) hyper-SI in 12 (38%). Among the 18 enlarged glands that had contrast MR, 15 (83%) had peripheral rim enhancement, 1 (6%) had homogeneous enhancement, and the last two (11%) had heterogeneous enhancement. MR characteristics can reveal certain pathological changes of adrenal tuberculosis, and MR imaging could be recommended as the imaging modality for the diagnosis of the entity.