An autopsy case of unexpected death due to Addison\u2019s disease caused by adrenal tuberculosis

Nan Zhao,Chunsheng Ni,Baocun Sun,Danfang Zhang,Yanlei Li,Yutong Gao,Xiulan Zhao

doi:10.1186/s40001-021-00611-w

Abstract

BackgroundAdrenal tuberculosis is difficult to diagnose due to non-specific symptom. Unexpected death due to adrenal insufficiency after trauma surgery is rare.Case presentationA 45-year-old man, who was admitted to hospital because of trauma to the right hand, died unexpectedly on the 13th day after replantation of amputated fingers. He was diagnosed with brain edema and diluted hyponatremia. Autopsy and histopathologic examination revealed severe brain edema combined with cerebellar tonsillar hernia, extensive destruction of adrenal gland caused by bilateral adrenal tuberculosis and right lung invasive pulmonary tuberculosis.ConclusionsTrauma and pulmonary tuberculosis complicated with adrenal tuberculosis induced the adrenal crisis, which eventually lead to severe cerebral edema and hernia, and finally death from respiratory and circulatory failure. This autopsy and histopathologic examination suggested a possible pathophysiologic mechanism of sudden death due to diluted hyponatremia after trauma surgery.

Highlights

Thomas Addison first described the clinical presentation of primary adrenocortical insufficiency in 1855 and Trousseau defined an adrenal insufficiency as an Addison’s disease (AD) in 1856 [1, 2]
Trauma and pulmonary tuberculosis complicated with adrenal tuberculosis induced the adrenal crisis, which eventually lead to severe cerebral edema and hernia, and death from respiratory and circulatory failure
According to a retrospective analysis of autopsies and adrenalectomies reviewed by K Y Lam and C Y Lo, the adrenal gland was the only extrapulmonary organ involved by tuberculosis in 14 of these 55 patients (25%; 35 men and 20 women).They found

Summary

Conclusions

Trauma and pulmonary tuberculosis complicated with adrenal tuberculosis induced the adrenal crisis, which eventually lead to severe cerebral edema and hernia, and death from respiratory and circulatory failure. This autopsy and histopathologic examination suggested a possible pathophysiologic mechanism of sudden death due to diluted hyponatremia after trauma surgery

Introduction

Discussion