Acute Adrenal Insufficiency Associated with Tuberculous Vertebral Osteomyelitis and Lymphadenopathy: Case Report | Zendy

İnan Anaforoğlu | Zendy; Ekrem Algün | Zendy; Ömer İnceçayır | Zendy; Çiğdem Şiviloḡlu | Zendy; İsmail Caymaz | Zendy

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Acute Adrenal Insufficiency Associated with Tuberculous Vertebral Osteomyelitis and Lymphadenopathy: Case Report

Author(s) -

İnan Anaforoğlu,

Ekrem Algün,

Ömer İnceçayır,

Çiğdem Şiviloḡlu,

İsmail Caymaz

Publication year - 2012

Publication title -

case reports in medicine

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 0.2

H-Index - 20

eISSN - 1687-9627

pISSN - 1687-9635

DOI - 10.1155/2012/574845

Subject(s) - medicine , adrenal insufficiency , tuberculosis , pyrazinamide , differential diagnosis , vomiting , orthostatic vital signs , hyponatremia , ethambutol , osteomyelitis , lymph node biopsy , biopsy , radiology , surgery , rifampicin , pathology , blood pressure

A 51-year-old man developed anorexia, dizziness, nausea, vomiting, and weight loss. He had orthostatic hypotension, hyponatremia, hyperkalemia, and hypocortisolemia, and the diagnosis of adrenal insufficiency was made. Magnetic resonance imaging (MRI) showed asymmetrically enlarged adrenal glands. Biopsy of a hypoechoic, enlarged, inguinal lymph node showed caseating granulomas. Lumbar MRI showed vertebral body height loss and abnormal signal in L1 and L2; vertebral biopsy showed chronic, necrotic, caseating granulomatous inflammation consistent with tuberculous osteomyelitis. Clinical improvement occurred with isoniazid, rifampicin, pyrazinamide, and corticosteroids. The differential diagnosis of adrenal insufficiency should include tuberculosis, especially in geographic regions where tuberculosis is endemic.

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