Table 1
Salient features of various adrenal infections.
| | Organism | Imaging findings | Comments |
| | 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 |
| | HIV | Depends 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 enlargement | Nearly 50% have adrenal involvement |
| | Paracoccidioides | Bilateral adrenal enlargement | Endemic in South America. Adrenal insufficiency does not always improve with treatment of the infection |
| | Blastomyces dermatitidis | Bilateral adrenal enlargement | Similar to paracoccidioidomycosis, overt adrenal insufficiency is less common |
| | Human cytomegalovirus infection | Variable | One of the most common adrenal infections in patients with AIDS. Insufficiency can manifest even when the patient is on glucocorticoid replacement |
| | Bacterial sepsis | Adrenal hemorrhage | A number of bacteria are associated with the Waterhouse-Friderichsen syndrome. Most commonly seen when encapsulated organisms cause overwhelming sepsis |
| | Echinococcus sp. | Adrenal cysts | Causes 6-7% of all adrenal cysts. Treatment is with surgery and albendazole |
| | Trypanosoma sp. | Variable | Adrenals may be the reservoir for T.cruzi while T.brucei (African sleeping sickness) causes mixed central/peripheral adrenal insufficiency |
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