International Journal of Endocrinology / 2014 / Article / Tab 1

Review Article

Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

Table 1

Salient features of various adrenal infections.

OrganismImaging findingsComments

Mycobacterium tuberculosis Bilateral adrenal enlargement
(active infection). Atrophy and calcification in remote infection
Adrenal enlargement improves with treatment; adrenal insufficiency does not. Steroid dose should be increased if on rifampin

HIVDepends on the etiology
(multiple OIs can involve the adrenals)
Adrenal insufficiency due to viral, fungal, mycobacterial infiltration. “Pseudo-Cushing’s” due to antiretroviral drugs and impaired cortisol metabolism

Histoplasma capsulatum Bilateral adrenal enlargementNearly 50% have adrenal involvement

Paracoccidioides Bilateral adrenal enlargementEndemic in South America. Adrenal insufficiency does not always improve with treatment of the infection

Blastomyces dermatitidis Bilateral adrenal enlargementSimilar to paracoccidioidomycosis, overt adrenal insufficiency is less common

Human cytomegalovirus infectionVariableOne of the most common adrenal infections in patients with AIDS. Insufficiency can manifest even when the patient is on glucocorticoid replacement

Bacterial sepsisAdrenal hemorrhageA number of bacteria are associated with the Waterhouse-Friderichsen syndrome. Most commonly seen when encapsulated organisms cause overwhelming sepsis

Echinococcus sp.Adrenal cystsCauses 6-7% of all adrenal cysts. Treatment is with surgery and albendazole

Trypanosoma sp.VariableAdrenals may be the reservoir for T.cruzi while T.brucei (African sleeping sickness) causes mixed central/peripheral adrenal insufficiency