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.

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