Miliary Tuberculosis Causing Presumed Primary Adrenal Insufficiency and Addisonian Crisis: A Case Report from Rural Kenya

Primary adrenal insufficiency (Addison’s disease) is characterized by inadequate production of cortisol from the adrenal glands due to diseases of the adrenal gland. Due to the insidious onset and non-specific nature of the symptoms of adrenal insufficiency, diagnosis is often delayed until patients present with an adrenal crisis. The three most common causes are autoimmune adrenalitis, infections, e.g., disseminated tuberculosis, HIV, systemic mycoses, and adrenal hemorrhage or infarction. Miliary tuberculosis of the adrenal gland occurs in high-TB burden populations by hematogenous spread of tuberculous bacilli to the gland, causing caseous necrosis, or by extra-adrenal infection and rifampicin-induced adrenal insufficiency. In this study, we report on the case of a middle-aged woman in rural Kenya who initially presented with missed features of adrenal insufficiency and subsequently went into an adrenal (Addisonian) crisis, which was successfully managed with glucocorticoids, fluids, and supportive therapy.