García RMT, Arenas R, Arellano BRH, Rull RJA

Language: Spanish
References: 24
Page: 281-285
PDF size: 215.66 Kb.

ABSTRACT

We present the case of a patient with mucocutaneous hyperpigmentation who was studied and diagnosed with primary adrenal insufficiency caused by tuberculosis. The diagnosis of primary adrenal insufficiency must be suspected and sought in every patient who presents with diffuse progressive cutaneous hyperpigmentation. In developing countries both an autoimmune and an infectious etiology must be sought, especially tuberculosis. An active infection must be treated with antituberculous drugs and hormonal replacement must be given with hydrocortisone, fludrocortisone and dehydroepiandrosterone. This case illustrates the importance of making a differential diagnosis in a patient with mucocutaneous hyperpigmentation.

REFERENCES

1. Arlt W, Allolio B. Adrenal insufficiency. Lancet 2003;361 (9372):1881-1893.

2. Zelissen PM, Bast EJ, Croughs RJ. Associated autoimmunity in Addison’s disease. J Autoimmun 1995;8(1):121-130.

3. García-Pascual L, Simó-Canonge R, Mesa-Manteca J y col. Enfermedad de Addison: un estudio clínico-epidemiológico de 45 casos. Rev Clin Esp 1990;187(2):49-52.

4. Agarwal G, Bhatia E, Pandey R, et al. Clinical profile and prognosis of Addison’s disease in India. Natl Med J India 2001;14:23-25.

5. Soule S. Addison’s disease in Africa: a teaching hospital experience. Clin Endocrinol (Oxf) 1999;50(1):115-120.

6. Sánchez-Laparade JR, Posadas-Romero C. Enfermedad de Addison: Estudio de 3 casos. Dermatología Rev Mex 1974;XVIII(2-3):116-123.

7. Alevritis EM, Sarubbi FA, Jordan RM, et al. Infectious causes of adrenal insufficiency. South Med J 2003;96(9):888-890.

8. Barnard C, Kanani R, Friedman JN. Her tongue tipped us off. CMAJ 2004;171(5):451.

9. Anglin RE, Rosebush PI, Mazurek MF. The neuropsychiatric profile of Addison’s disease: revisiting a forgotten phenomenon. J Neuropsychiatry Clin Neurosci 2006;18(4):450-459.

10. Serter R, Koc G, Demirbas B. Acute adrenal crisis together with unilateral adrenal mass caused by isolated tuberculosis of adrenal gland. Endocr Pract 2003;9(2):157-161.

11. Grimes P, Nordlund JJ, Pandya AG, et al. Increasing our understanding of pigmentary disorders. J Am Acad Dermatol 2006;54:S255-S261.

12. Gantz I, Fong TM. The melanocortin system. Am J Physiol Endocrinol Metab 2003;284:E468-E474.

13. Wolff K, Goldsmith LA, Katz SI. Fitzpatrick’s Dermatology in General Medicine. McGraw-Hill, 2008.

14. Kasper DL, Braunwald E, Fauci AS, et al. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill, 2004.

15. Lanzas-Prieto JM, Guate-Ortiz JL, González-Tuero J, et al. Adrenal tuberculosis. Diagnosis using PCR. Arch Esp Urol 1997;50(7):802-804.

16. Guo YK, Yang ZG, Li Y, et al. Addison’s disease due to adrenal tuberculosis: contrast-enhanced Ct features and clinical duration correlation. Eur J Radiol 2007;62(1):126- 131.

17. Zhang XC, Yang ZG, Li Y, et al. Addison’s disease due to adrenal tuberculosis: MRI features. Abdom Imaging 2008;33(6):689-694.

18. Jedrzejowski M, Frzesiuk W, Pawlik-Pachucka E, et al. Adrenal tuberculosis as a cause of primary adrenal insufficiency-case report. Pol Merkur Lekarski 2005;19(110):193-195.

19. Barnhill RL, Crowson AN. Textbook of Dermatopathology. McGraw-Hill, 2004.

20. Lam KY, Lo CY. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin Endocrinol (Oxf) 2001;54(5):633-639.

21. Hahner S, Allolio B. Management of adrenal insufficiency in different clinical settings. Expert Opin Pharmacother 2005;6(14):2407-2417.

22. Stoffer SS. Addison’s disease. How to improve patients’ quality of life. Postgrad Med 1993;93(4):265-266.

23. Bhatia E, Jain SK, Gupta RK. Tuberculous Addison’s disease: lack of normalization of adrenocortical function after antituberculous chemotherapy. Clin Endocrinol (Oxf) 1998;48(3):355- 359.

24. Bergthorsdottir R, Leonsson-Zachrisson M, et al. Premature mortality in patients with Addison’s disease: a population-based study. J Clin Endocrinol Metab 2006;91(12):4849-4853.