Case ReportAdrenal tuberculosis mimicking a malignancy by direct hepatic invasion: emphasis on adrenohepatic fusion as the potential route
Section snippets
Case report
A 64-year-old female presented with general weakness for 2 months. The laboratory tests revealed primary adrenal insufficiency [i.e., hyponatremia, 128mmol/l; high adrenocorticotropic hormone (ACTH), 1026 pg/ml; no appropriate increase of cortisol in the rapid ACTH stimulation test]. The dedicated adrenal computed tomography (CT), which consisted of unenhanced CT, and 1-mine and 15-min enhanced CT, was performed to evaluate the adrenal gland.
CT images showed a soft tissue mass, measuring 3.2
Discussion
Typical radiologic features of the adrenal tuberculosis include bilateral enlargement of the adrenal glands showing peripheral enhancement and central necrotic areas, with or without calcifications [1], [2], [3]. As the disease advances, normal adrenal tissues are more destroyed, resulting in adrenal insufficiency. In addition, concurrent or previous extra-adrenal involvement such as pulmonary tuberculosis may be helpful for the diagnosis of adrenal tuberculosis [4]. When these typical
Conclusion
In conclusion, the adrenal tuberculosis may invade the adjacent liver when it occurs in right adrenal gland because the adrenohepatic fusion may exist as a potential route for the spread. The findings of nonadenoma on dedicated adrenal CT as well as high uptake on 18F-FDG PET/CT can be also seen, as previously reported. The awareness of these radiologic features of adrenal tuberculosis may enable to perform additional laboratory tests or image-guided biopsy for assessing tuberculous infection,
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Adrenal Tuberculosis: A Case Report and Literature Review
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