Addisonian crisis and tuberculous epididymo-orchitis

Yin Chian Kon, Mitchell Sokoloff, Francis H. Straus, Roy E Weiss

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To describe a case of acute primary adrenal insufficiency in which tuberculosis was subsequently detected as the etiologic factor when the patient presented with tuberculous epididymo-orchitis. Methods: A case of acute primary adrenal insufficiency associated with bilaterally enlarged adrenal glands is reported, along with the subsequent finding of a scrotal mass diagnosed as tuberculous epididymo-orchitis. Diagnosis, adrenal function, and results of imaging studies after institution of antituberculous treatment are discussed. Results: A 41-year-old Egyptian man, who had immigrated to the United States 5 years previously, had acute psychosis and addisonian crisis. A substantially increased early morning level of plasma adrenocorticotropic hormone and a low level of serum cortisol confirmed the diagnosis of primary adrenal insufficiency. Both adrenal glands were enlarged but without calcification on computed tomography. A previous bacille Calmette-Guérin vaccination complicated the interpretation of a positive tuberculin skin test result. Both lungs were clear on chest radiography and computed tomography. Seven months later, the patient had a left scrotal mass and underwent radical orchiectomy. Examination of the pathology specimen showed caseous granulomatous inflammation and necrosis, and acid-fast bacilli were identified. Culture was positive for Mycobacterium tuberculosis. Conclusion: In a patient from a country where tuberculosis is endemic, tuberculosis should be considered in the differential diagnosis when primary adrenal insufficiency is detected, especially in association with enlarged or calcified adrenal glands. Extra-adrenal tuberculous involvement should be actively sought because it may provide indirect microbiologic or histologic clues. Other than the lungs, special attention should be paid to the genitourinary system.

Original languageEnglish (US)
Pages (from-to)365-369
Number of pages5
JournalEndocrine Practice
Volume8
Issue number5
StatePublished - Sep 2002
Externally publishedYes

Fingerprint

Orchitis
Addison Disease
Adrenal Glands
Tuberculosis
Tomography
Urogenital System
Lung
Tuberculin Test
Orchiectomy
Skin Tests
Mycobacterium tuberculosis
Radiography
Psychotic Disorders
Adrenocorticotropic Hormone
Bacillus
Hydrocortisone
Vaccination
Differential Diagnosis
Necrosis
Thorax

ASJC Scopus subject areas

  • Endocrinology

Cite this

Kon, Y. C., Sokoloff, M., Straus, F. H., & Weiss, R. E. (2002). Addisonian crisis and tuberculous epididymo-orchitis. Endocrine Practice, 8(5), 365-369.

Addisonian crisis and tuberculous epididymo-orchitis. / Kon, Yin Chian; Sokoloff, Mitchell; Straus, Francis H.; Weiss, Roy E.

In: Endocrine Practice, Vol. 8, No. 5, 09.2002, p. 365-369.

Research output: Contribution to journalArticle

Kon, YC, Sokoloff, M, Straus, FH & Weiss, RE 2002, 'Addisonian crisis and tuberculous epididymo-orchitis', Endocrine Practice, vol. 8, no. 5, pp. 365-369.
Kon YC, Sokoloff M, Straus FH, Weiss RE. Addisonian crisis and tuberculous epididymo-orchitis. Endocrine Practice. 2002 Sep;8(5):365-369.
Kon, Yin Chian ; Sokoloff, Mitchell ; Straus, Francis H. ; Weiss, Roy E. / Addisonian crisis and tuberculous epididymo-orchitis. In: Endocrine Practice. 2002 ; Vol. 8, No. 5. pp. 365-369.
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