title: Addison's disease due to tuberculosis that required differentiation from SIADH.
abstract: A 77-year-old man was admitted to our hospital complaining of general fatigue. Serum sodium was 116 mEq/l and serum antidiuretic hormone (ADH) was elevated. Radiologic examination revealed nodules in the brain as well as in both adrenal glands. Based on the findings of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), we had considered that the cause of the hyponatremia was syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to active extrapulmonary tuberculosis. Against our expectations, the patient's condition got worse just after he began antituberculous therapy; we finally diagnosed Addison's disease by additional hormonal tests. His condition recovered immediately with the administration of high-dose hydrocortisone, and the tuberculous lesions became smaller with antituberculous medications. Although tuberculous Addison's disease has been decreasing markedly in recent years, we have to consider the possibility of adrenal insufficiency when hyponatremia is observed in patients with active tuberculosis or those having a past history of tuberculosis.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Okinawa Hospital, Okinawa, Japan. kumanomis6@yahoo.co.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kinjo
authors.forename: Daisuke
authors.initials: D
authors.lastname: Higuchi
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Oshiro
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakamatsu
authors.forename: Kaori
authors.initials: K
authors.lastname: Fujita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakamoto
authors.forename: Isoko
authors.initials: I
authors.lastname: Owan
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagi
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Kuba
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujita
mesh_terms: D000224:Addison Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007177:Inappropriate ADH Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D009169:Mycobacterium tuberculosis; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D014383:Tuberculosis, Endocrine / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D006854:Hydrocortisone