Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Case Report Urol Int 2006;76:285–287 DOI: 10.1159/000091637 Primary Adrenal Tuberculosis: Role of Computed Tomography and CT-Guided Biopsy in Diagnosis E.N. Liatsikos a C.P. Kalogeropoulou b Z. Papathanassiou b I. Tsota b A. Athanasopoulos a P. Perimenis a G.A. Barbalias a T. Petsas b Departments of a Urology and b Radiology, School of Medicine, University of Patras, Patras, Greece Case Report A 25-year-old man, immigrant from Albania, was admitted with a 4-week history of lumbar pain, weakness, significant weight loss ( 14 kg) and anorexia. The patient had no chest pain, cough and/ or hemoptysis. On physical examination, signs of orthostatic hypo- tension were depicted and his temperature was 38.5 ° C. Lung aus- cultation and chest X-rays were negative for pathological signs. Arterial blood gas values were within normal limits. Laboratory in- vestigations were significant for an increase of the erythrocyte sedimentation rate (123 mm/h) and the C-reactive protein levels (17 mg/dl). Also, a low level of 75 mg/dl of fasting glucose plas- ma was reported. Apart from a mild decrease of sodium (Na + 130 mEq/l), serum electrolytes, white blood cell count and renal function tests were not affected. The Mantoux reaction test was positive ( 13 mm). Adrenal insufficiency was confirmed by the ACTH stimulation test (table 1) and the patient immediately un- derwent treatment with i.v. infusion of saline and glucocorticoids. Blood, urine, throat, sputum and stool specimens were negative for any kind of infection. Key Words Primary adrenal tuberculosis  CT scan Abstract A case of isolated, bilateral, adrenal tuberculosis is pre- sented. A 25-year-old male was admitted to the hospital due to lumbar pain, fever, weight loss and anorexia. Ab- dominal ultrasonography and computed tomography demonstrated bilateral adrenal enlargement. Laboratory investigations were remarkable for adrenal insufficien- cy. The Mantoux reaction was positive but there was no evidence of lung or urinary infection. CT-guided biopsy of the left adrenal gland was performed and established the diagnosis of adrenal tuberculosis. Copyright © 2006 S. Karger AG, Basel Introduction Isolated adrenal tuberculosis (TB) combined with ad- renal insufficiency describes a rare and usually irrevers- ible clinical condition [1]. Diagnostic differentiation is cumbersome because its clinical profile and imaging fea- tures are usually lacking specificity and only histological examination can define the final diagnosis [2]. Received: June 10, 2005 Accepted: August 23, 2005 Internationalis Urologia Evangelos N. Liatsikos, MD, PhD, Lecturer of Urology Department of Urology, University of Patras Medical School Rio, Patras, 26 500 (Greece) Tel. +30 2610 999385, Fax +30 2610 993981 E-Mail Liatsikos@yahoo.com © 2006 S. Karger AG, Basel 0042–1138/06/0763–0285$23.50/0 Accessible online at: www.karger.com/uin Table 1. Results of the ACTH stimulation test at the time of ad- mission Cortisol, g/dl Patient values Normal range Basal 3 5–25 After i.v. infusion of ACTH (60 min) 12.5 117