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Case Reports in Medicine
Volume 2012, Article ID 574845, 4 pages
http://dx.doi.org/10.1155/2012/574845
Case Report

Acute Adrenal Insufficiency Associated with Tuberculous Vertebral Osteomyelitis and Lymphadenopathy: Case Report

1Department of Endocrinology and Metabolism, Trabzon Numune Education and Research Hospital, 61000 Trabzon, Turkey
2Department of Pathology, Trabzon Numune Education and Research Hospital, 61000 Trabzon, Turkey
3Department of Radiology, Trabzon Numune Education and Research Hospital, 61000 Trabzon, Turkey

Received 8 December 2011; Revised 1 February 2012; Accepted 23 February 2012

Academic Editor: Abhay R. Satoskar

Copyright © 2012 İnan Anaforoğlu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 51-year-old man developed anorexia, dizziness, nausea, vomiting, and weight loss. He had orthostatic hypotension, hyponatremia, hyperkalemia, and hypocortisolemia, and the diagnosis of adrenal insufficiency was made. Magnetic resonance imaging (MRI) showed asymmetrically enlarged adrenal glands. Biopsy of a hypoechoic, enlarged, inguinal lymph node showed caseating granulomas. Lumbar MRI showed vertebral body height loss and abnormal signal in L1 and L2; vertebral biopsy showed chronic, necrotic, caseating granulomatous inflammation consistent with tuberculous osteomyelitis. Clinical improvement occurred with isoniazid, rifampicin, pyrazinamide, and corticosteroids. The differential diagnosis of adrenal insufficiency should include tuberculosis, especially in geographic regions where tuberculosis is endemic.