A case of tuberculosis of adrenal gland presenting as acute adrenal insufficiency following initiation of anti-tubercular therapy

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dc.contributor.authorVijayakumar, Ben_US
dc.contributor.authorMeganathan, Aen_US
dc.contributor.authorRanganathan, SDen_US
dc.contributor.authorPaulchamy, B.en_US
dc.date.accessioned2025-05-09T09:48:19Z
dc.date.available2025-05-09T09:48:19Z
dc.date.issued2024-12
dc.description.abstractAdrenal tuberculosis is one important cause of acute or chronic adrenal insufficiency in developing countries like India. There are many random cases in literature describing various clinical situations of adrenal tuberculosis presenting with adrenal insufficiency, especially after initiation of anti-tubercular therapy. A 43-year-old male recently diagnosed patient with pulmonary tuberculosis and chronic coronary syndrome was admitted for acute decompensated heart failure with pulmonary edema. He was taking fixed dose combination anti-tubercular therapy. During admission, he had hyponatremia (serum sodium 96 mEq/L) and during treatment, he developed hypotension and shock, which were appropriately treated. Due to ischemic hepatitis, anti-tubercular treatment (ATT) was modified to streptomycin, ethambutol, and ofloxacin regimen to avoid further hepatotoxicity. Hyponatremia and shock recovered. Rifampicin and isoniazid were restarted. He again developed easy fatigability, nausea, vomiting, and hypotension. Suspecting adrenal insufficiency, fasting serum cortisol, and adrenocorticotropic hormone (ACTH) were done, which revealed a low serum fasting cortisol and high ACTH. Computed tomography abdomen showed enlarged left adrenal gland with calcifications. He was started on prednisolone 2 mg/ kg/day with full dose fixed dose ATT, following which his symptoms resolved.en_US
dc.identifier.affiliationsDepartment of Medicine and Medical Specialities, Dr. Jeyasekharan Medical Trust, Nagercoil, Tamil Nadu, Indiaen_US
dc.identifier.affiliationsDepartment of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, Indiaen_US
dc.identifier.affiliationsDepartment of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, Indiaen_US
dc.identifier.affiliationsDepartment of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, India.en_US
dc.identifier.citationVijayakumar B, Meganathan A, Ranganathan SD, Paulchamy B.. A case of tuberculosis of adrenal gland presenting as acute adrenal insufficiency following initiation of anti-tubercular therapy. Indian Journal of Medical Sciences. 2024 Dec; 76(3): 137-139en_US
dc.identifier.issn1998-3654
dc.identifier.issn0019-5359
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/244940
dc.languageenen_US
dc.publisherScientific Scholaren_US
dc.relation.issuenumber3en_US
dc.relation.volume76en_US
dc.source.urihttps://dx.doi.org/10.25259/IJMS_46_2024en_US
dc.subjectAdrenal insufficiencyen_US
dc.subjectRifampicinen_US
dc.subjectTuberculosisen_US
dc.titleA case of tuberculosis of adrenal gland presenting as acute adrenal insufficiency following initiation of anti-tubercular therapyen_US
dc.typeJournal Articleen_US
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