ACUTE ADRENAL INSUFFICIENCY OF TUBERCULOSIS ORIGIN: CLINICAL CASE

AdrenalTuberculosis is arare and difficult condition to diagnose. It issometimesdiscoveredduring the etiologicalassessment of adrenalinsufficiency. Hereafter, is a report of a rare case of adrenaltuberculosis revealed through acute adrenal insufficiency, associatedwithcutaneoustuberculosiswithout an active pulmonary component.

Adrenal coma hormone therapy case

When diagnosing various coma, one should bear in mind the possibility of coma due to acute adrenal insufficiency, which develops as a result of partial or complete destruction of the adrenal glands in infectious diseases, adrenal hemorrhages, adrenal vascular thrombosis or surgery on the adrenal glands.

Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

Context Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusions Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

Adrenal Tuberculosis Leading to Acute Adrenal Insufficiency

Background: Tuberculosis is the ‘world’s largest killer’ amongst infectious diseases overtaking HIV in 2014. Tuberculosis can affect the kidneys and adrenals as either primary infection or secondary dissemination from other organs. Tuberculosis in adrenals manifests in the acute phase leading to primary adrenal insufficiency, which is generally catastrophic leading to death. Case Report: We present an unusual case of a 42 years’ old man, presented & managed as a case of acute gastroenteritis. Patient had a fulminant course and succumbed to his illness. Autopsy revealed Bilateral Adrenal Tuberculosis. Conclusion: Adrenal tuberculosis has the potential of causing acute adrenal deficiency leading to Addisonian crisis and consequent mortality. Key words: Adrenal tuberculosis, Addisonian crisis, acute adrenal insufficiency.

Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms

Gastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association “Adrenals” (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.