A Case of Unilateral Adrenal Tuberculosis in an Ethiopian Patient Presenting as a Tumor: A Diagnostic Challenge in a Resource-Limited Setup

Tuberculosis remains a major public health burden in developing countries, with adrenal involvement being rare and typically bilateral. Isolated adrenal tuberculosis accounts for 1%-2% of adrenal masses and often presents with nonspecific symptoms. Its imaging findings can mimic primary adrenal tumors. Hereby we report a 66-year-old male from the Tigray region of Ethiopia presented with a one-year history of right flank pain and weight loss. A computed tomography scan revealed a 5 cm right adrenal mass with an impression of a primary adrenal tumor. His routine laboratory test results were within normal range except for the elevated erythrocyte sedimentation rate. Histopathological examination following open adrenalectomy revealed caseating granulomatous inflammation suggesting adrenal tuberculosis. A subsequent acid-fast bacilli stain was done from the tissue block, and it was positive. Adrenal function tests and hormonal levels were planned, but the tests were not available at our center. The patient was started on anti-tuberculous therapy, and he has recovered upon completion of the regimen. In a suspected case of adrenal tuberculosis presenting with a mass lesion, the patient should be referred to better setups for minimally invasive tests like ultrasound-guided fine needle aspiration cytology and assessment of adrenal function.