A Rare Case of Adrenal Tuberculosis Mimicking a Tumor: Diagnostic Pitfalls

Adrenal tuberculosis is a rare condition, accounting for 3% to 9% of adrenal insufficiency etiologies. It is responsible for a clinical table of acute or chronic adrenal insufficiency. We report a case of an adrenal mass with a misleading pseudotumoral radiological appearance in a patient initially addressed for preoperative evaluation of this “adrenal mass”. The clinico-biological evaluation of this mass indicated a tubercular origin, thus avoiding an unnecessary surgery. This 43-year-old patient initially presented with non-specific abdominal pain, prompting an abdominal tomography in favor of a pseudotumoral right adrenal mass with an initial indication for adrenalectomy. Clinical evaluation revealed weight loss and diffuse melanoderma. The diagnosis of peripheral adrenal insufficiency was confirmed by a low cortisol level measured at 8 a.m. and a very high ACTH level. As part of the etiological investigation, the Quantiferon test proved strongly positive at 10 IU/ml. The diagnosis of adrenal tuberculosis was confirmed on the basis of these clinical, biological, and radiological findings. The patient was treated with hydrocortisone (30 mg/day) and antituberculosis therapy. The evolution is marked by clinical improvement—disappearance of asthenia, regression of melanoderma and normalization of blood pressure—and biological improvement after three months.