title: Evolving adrenal insufficiency.
abstract: BACKGROUND
  Tuberculosis is the most common cause of Addison's disease in India. The exact status of adrenal reserve in tuberculosis is still an enigma and recovery of adrenal function is unpredictable.
  
  
  OBJECTIVE
  We report a case with a pre-Addisonian state and unchanged adrenal size after 1 year treatment.
  
  
  METHODS
  A 31-year patient with adrenal tuberculosis was diagnosed and treated with anti tubercular drugs (ATDs) and steroid.
  
  
  RESULTS
  A 31-year male, presented with fever and weight loss for 3½ months with anorexia, nausea, hyperpigmentation of skin, and buccal mucosa and weakness with past h/o adequately treated pulmonary tuberculosis at 3 years of age. On examination, the patient was anemic. A non-tender, firm right (Rt.) submandibular lymphnode was palpable. Investigations revealed: High erythrocyte sedimentation rate (ESR), negative HIV, and sputum for acid fast bacilli (AFB). Initial cortisol was high but subsequently became low with negative short synacthin test (SST). Computed tomography showed bilateral (B/L) enlarged hypodense adrenal mass with inconclusive fine needle aspiration cytology (FNAC) and negative AFB culture. Rt. submandibular lymph node FNAC showed caseating granuloma. ATDs and steroids were started, the lymphadenopathy regressed and symptoms subsided. However, after 1 year of treatment steroid withdrawal failed and adrenal size remained the same.
  
  
  CONCLUSIONS
  The adrenal has considerable capacity to regenerate during active infection and ultimately become normal or smaller in size. However, in the case reported here, they failed to regress. Reversal of adrenal function following ATD is a controversial issue. Some studies have shown normalization following therapy, while others have contradicted it similar to the finding in our case.
authors.affiliation: Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India.
authors.forename: Ajitesh
authors.initials: A
authors.lastname: Roy
authors.forename: Rana
authors.initials: R
authors.lastname: Bhattacharjee
authors.forename: Soumik
authors.initials: S
authors.lastname: Goswami
authors.forename: Anubhav
authors.initials: A
authors.lastname: Thukral
authors.forename: S
authors.initials: S
authors.lastname: Chitra
authors.forename: Partha Pratim
authors.initials: PP
authors.lastname: Chakraborty
authors.forename: Dayanidhi
authors.initials: D
authors.lastname: Meher
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
authors.forename: Satinath
authors.initials: S
authors.lastname: Mukhopadhyay
authors.forename: Subhankar
authors.initials: S
authors.lastname: Chowdhury
keywords: Evolving adrenal insufficiency anti tubercular drugs; Tuberculosis
references.citation: Postgrad Med J. 1992 Mar;68(797):204-5
references.pmid: 1589379
references.citation: Thorax. 1989 May;44(5):422-4
references.pmid: 2763243