When Tissue Is the Issue: Presumptive Diagnosis and Treatment of Bilateral Adrenal Tuberculosis
https://doi.org/10.15605/jafes.041.S1
- Author:
Norul Ain Mat Seman
1
;
Maslina Hanuni Ma
2
;
Wan Hafez Wan Hamzah
2
Author Information
1. Department of Internal Medicine, Hospital Sultanah Nur Zahirah
2. Endocrinology Unit, Hospital Sultanah Nur Zahirah
- Publication Type:Journal Article
- MeSH:
Tuberculosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):30-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Adrenal tuberculosis (TB) is a rare but important cause
of adrenal insufficiency in TB-endemic regions, usually
secondary to pulmonary or extrapulmonary disease, with
primary involvement being uncommon. It typically affects
both glands via hematogenous or lymphatic spread and
presents late with nonspecific features after significant
adrenal destruction, making diagnosis challenging.
Diagnosis is more straightforward in the presence of extraadrenal TB, where imaging may obviate the need for biopsy,
but remains difficult in isolated adrenal involvement.
Case:We report a 69-year-old Malay male with diabetes
mellitus, hypertension, and hyperlipidemia who presented
with a 2-week history of chronic cough and 4 months
of constitutional symptoms, including weight loss and
anorexia. Initial TB workup in September 2025 was negative.
He was subsequently admitted twice in October 2025 for
pneumonia, with persistent upper lobe consolidation on
chest radiography despite antibiotics.
Contrast-enhanced computed tomography thorax,
abdomen, and pelvis revealed bilateral mildly enhancing
hypodense adrenal lesions (right 3.7 × 3.0 cm, left 2.5 × 2.6
cm), suggestive of adenoma, hyperplasia, or lymphoma.
Bronchoscopy detected Mycobacterium tuberculosis via
GeneXpert BAL, with no malignant cells on cytology.
Adrenal biopsy was non-diagnostic.
Biochemical evaluation showed low morning cortisol
with elevated adrenocorticotropic hormone and findings
consistent with adrenal insufficiency. The patient was
treated as smear-negative pulmonary TB with adrenal
involvement and initiated on anti-TB therapy, currently in
the maintenance phase. Hydrocortisone replacement 10 mg
twice daily was also initiated.
Conclusion:This case highlights the diagnostic challenge of adrenal
TB, particularly when tissue sampling is inconclusive. In TB-endemic settings, a presumptive diagnosis based on
clinical, radiological, and microbiological evidence is often
necessary. Early empiric anti-TB therapy is essential to
prevent adrenal crisis and preserve endocrine function.
- Full text:2026072814101180158EP_A021.pdf
