title: Adrenal histoplasmosis: unusual presentations.
abstract: BACKGROUND
  Histoplasmosis has been sporadically reported from India. Though asymptomatic adrenal involvement has been described in patients with disseminated histoplasmosis; isolated adrenal involvement with adrenal insufficiency (AI) as the presenting manifestation of the disease is rare.
  
  
  METHODS
  We describe 5 immunocompetent men (mean age 55.6 yrs) from a nonendemic area with adrenal histoplasmosis presenting with constitutional symptoms. Three patients had AI at presentation with bilateral adrenal involvement and the other two developed AI during the course of the illness and had unilateral adrenal mass . All the patients had histopathological/cytologically proven adrenal histoplasmosis. 18FDG-PET done in 3 patients helped in delineating the extent of the disease. Adrenalectomy was done in 2 patients who presented with unilateral adrenal mass. All these patients received Amphotericin B and/or itraconazole treatment which led to symptomatic improvement but AI persisted in all at the end of the follow up of 6 to 18 months.
  
  
  CONCLUSIONS
  The diagnosis of adrenal histoplasmosis should be considered in patients presenting with constitutional symptoms and unilateral or bilateral adrenal mass/es with or without AI.
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
authors.forename: Sambit
authors.initials: S
authors.lastname: Das
authors.forename: Pinaki
authors.initials: P
authors.lastname: Dutta
authors.forename: Rama
authors.initials: R
authors.lastname: Walia
authors.forename: Uma
authors.initials: U
authors.lastname: Nahar
authors.forename: S K
authors.initials: SK
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Vellayutham
authors.forename: Shanmugasundar
authors.initials: S
authors.lastname: Gopal
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007121:Immunocompetence; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B