Evolving adrenal insufficiency
Introduction: Tuberculosis is the most common cause of Addison′s disease in India. The exact status of adrenal reserve in tuberculosis is still an enigma and recovery of adrenal function is unpredictable. Objective: We report a case with a pre-Addisonian state and unchanged adrenal size after 1 year...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2012-01-01
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| Series: | Indian Journal of Endocrinology and Metabolism |
| Subjects: | |
| Online Access: | http://www.ijem.in/article.asp?issn=2230-8210;year=2012;volume=16;issue=8;spage=369;epage=370;aulast=Roy |
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| author | Ajitesh Roy Rana Bhattacharjee Soumik Goswami Anubhav Thukral S Chitra Partha Pratim Chakraborty Dayanidhi Meher Sujoy Ghosh Satinath Mukhopadhyay Subhankar Chowdhury |
| author_facet | Ajitesh Roy Rana Bhattacharjee Soumik Goswami Anubhav Thukral S Chitra Partha Pratim Chakraborty Dayanidhi Meher Sujoy Ghosh Satinath Mukhopadhyay Subhankar Chowdhury |
| author_sort | Ajitesh Roy |
| collection | DOAJ |
| description | Introduction: Tuberculosis is the most common cause of Addison′s disease in India. The exact status of adrenal reserve in tuberculosis is still an enigma and recovery of adrenal function is unpredictable. Objective: We report a case with a pre-Addisonian state and unchanged adrenal size after 1 year treatment. Materials and Methods: A 31-year patient with adrenal tuberculosis was diagnosed and treated with anti tubercular drugs (ATDs) and steroid. Results: A 31-year male, presented with fever and weight loss for 3½ months with anorexia, nausea, hyperpigmentation of skin, and buccal mucosa and weakness with past h/o adequately treated pulmonary tuberculosis at 3 years of age. On examination, the patient was anemic. A non-tender, firm right (Rt.) submandibular lymphnode was palpable. Investigations revealed: High erythrocyte sedimentation rate (ESR), negative HIV, and sputum for acid fast bacilli (AFB). Initial cortisol was high but subsequently became low with negative short synacthin test (SST). Computed tomography showed bilateral (B/L) enlarged hypodense adrenal mass with inconclusive fine needle aspiration cytology (FNAC) and negative AFB culture. Rt. submandibular lymph node FNAC showed caseating granuloma. ATDs and steroids were started, the lymphadenopathy regressed and symptoms subsided. However, after 1 year of treatment steroid withdrawal failed and adrenal size remained the same. Conclusion: The adrenal has considerable capacity to regenerate during active infection and ultimately become normal or smaller in size. However, in the case reported here, they failed to regress. Reversal of adrenal function following ATD is a controversial issue. Some studies have shown normalization following therapy, while others have contradicted it similar to the finding in our case. |
| first_indexed | 2024-12-10T09:56:10Z |
| format | Article |
| id | doaj.art-800b03323d094f46adccd19b923504de |
| institution | Directory Open Access Journal |
| issn | 2230-8210 2230-9500 |
| language | English |
| last_indexed | 2024-12-10T09:56:10Z |
| publishDate | 2012-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Indian Journal of Endocrinology and Metabolism |
| spelling | doaj.art-800b03323d094f46adccd19b923504de2022-12-22T01:53:29ZengWolters Kluwer Medknow PublicationsIndian Journal of Endocrinology and Metabolism2230-82102230-95002012-01-0116836937010.4103/2230-8210.104096Evolving adrenal insufficiencyAjitesh RoyRana BhattacharjeeSoumik GoswamiAnubhav ThukralS ChitraPartha Pratim ChakrabortyDayanidhi MeherSujoy GhoshSatinath MukhopadhyaySubhankar ChowdhuryIntroduction: Tuberculosis is the most common cause of Addison′s disease in India. The exact status of adrenal reserve in tuberculosis is still an enigma and recovery of adrenal function is unpredictable. Objective: We report a case with a pre-Addisonian state and unchanged adrenal size after 1 year treatment. Materials and Methods: A 31-year patient with adrenal tuberculosis was diagnosed and treated with anti tubercular drugs (ATDs) and steroid. Results: A 31-year male, presented with fever and weight loss for 3½ months with anorexia, nausea, hyperpigmentation of skin, and buccal mucosa and weakness with past h/o adequately treated pulmonary tuberculosis at 3 years of age. On examination, the patient was anemic. A non-tender, firm right (Rt.) submandibular lymphnode was palpable. Investigations revealed: High erythrocyte sedimentation rate (ESR), negative HIV, and sputum for acid fast bacilli (AFB). Initial cortisol was high but subsequently became low with negative short synacthin test (SST). Computed tomography showed bilateral (B/L) enlarged hypodense adrenal mass with inconclusive fine needle aspiration cytology (FNAC) and negative AFB culture. Rt. submandibular lymph node FNAC showed caseating granuloma. ATDs and steroids were started, the lymphadenopathy regressed and symptoms subsided. However, after 1 year of treatment steroid withdrawal failed and adrenal size remained the same. Conclusion: The adrenal has considerable capacity to regenerate during active infection and ultimately become normal or smaller in size. However, in the case reported here, they failed to regress. Reversal of adrenal function following ATD is a controversial issue. Some studies have shown normalization following therapy, while others have contradicted it similar to the finding in our case.http://www.ijem.in/article.asp?issn=2230-8210;year=2012;volume=16;issue=8;spage=369;epage=370;aulast=RoyEvolving adrenal insufficiency anti tubercular drugsTuberculosis |
| spellingShingle | Ajitesh Roy Rana Bhattacharjee Soumik Goswami Anubhav Thukral S Chitra Partha Pratim Chakraborty Dayanidhi Meher Sujoy Ghosh Satinath Mukhopadhyay Subhankar Chowdhury Evolving adrenal insufficiency Indian Journal of Endocrinology and Metabolism Evolving adrenal insufficiency anti tubercular drugs Tuberculosis |
| title | Evolving adrenal insufficiency |
| title_full | Evolving adrenal insufficiency |
| title_fullStr | Evolving adrenal insufficiency |
| title_full_unstemmed | Evolving adrenal insufficiency |
| title_short | Evolving adrenal insufficiency |
| title_sort | evolving adrenal insufficiency |
| topic | Evolving adrenal insufficiency anti tubercular drugs Tuberculosis |
| url | http://www.ijem.in/article.asp?issn=2230-8210;year=2012;volume=16;issue=8;spage=369;epage=370;aulast=Roy |
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