Primary Adrenal Tuberculosis Causing Addison's Disease: A Rare Case Report and A brief Update on Diagnosis and Treatment.

BACKGROUND: Primary adrenal tuberculosis is a rare but significant cause of adrenal insufficiency (Addison's disease), particularly in regions where tuberculosis remains endemic. The destruction of the adrenal glands due to Mycobacterium tuberculosis leads to hormonal imbalances, which, if undiagnosed, can result in life-threatening adrenal crises.

CASE PRESENTATION: We report a rare case of a 54-year-old immunocompetent male who presented with progressive weight loss, generalized weakness, and hyperpigmentation over five months. Biochemical investigations revealed hyponatremia, hyperkalemia, low morning cortisol, and elevated adrenocorticotropic hormone (ACTH) levels, confirming primary adrenal insufficiency. Contrast-enhanced computed tomography (CECT) of the abdomen showed bilateral adrenal enlargement with central necrosis. A CT-guided adrenal biopsy revealed caseating granulomas, confirming adrenal TB. The patient was started on a standard anti-tuberculosis treatment (ATT) under the National Tuberculosis Elimination Programme (NTEP) guidelines, along with lifelong hormone replacement therapy.

CONCLUSION: This case highlights the importance of early diagnosis and prompt intervention in ad-renal TB to prevent complications. Adrenal TB remains a diagnostic challenge due to its nonspecific presentation. A multidisciplinary approach, integrating TB control programs with endocrinology, is vital for improving patient outcomes.