Tuberculosis adrenal insufficiency

Caution Adrenal insufficiency, cirrhosis, glaucoma, hypothyroidism, untreated infection, osteoporosis, tuberculosis, sensitivity to beclomethasone... 

Addisons disease, results from progressive destruction or dysfunction of the adrenal glands by a local disease process or systemic disorder (Box 51-12), Worldwide, infectious diseases are the most common cause of primary adrenal insufficiency and include tuberculosis, fongal infections (histoplasmosis and cryptococcosis), and cytomegalovirus infections. Autoimmune adrenalitis accounts for more than 70% of cases reported in the Western world, with adrenal autoantibodies noted in more than 75% of cases,. The adrenal glands are atrophic, with loss of cortical cells but an intact medulla. Almost 50% of patients with autoimmune adrenalitis have an associated autoimmune disease with autoimmune thyroid disease the most common. 

As described, in Addison s disease adrenal cortex function is inadequate. The most common cause of Addison s disease is the autoimmune destruction of the adrenal gland. (The major cause of adrenal insufficiency before the 1920s was tuberculosis of the adrenal gland.) Addison s disease also results from prolonged glucocorticoid therapy. (Recall that certain glucocorticoids are used as anti-inflammatory chugs.)... 

Fomierly, adrenal gland destruction was often due to tuberculosis autoimmune disease is now the main cause of primary adrenal failure. Both cortisol and itldosterone production may be affected. Secondary failure to produce cortisol is more common. Frequently, this is due to long-standing suppression and subsequent impairment of the hypothalamic-pituitary-adrenocortical axis from therapeutic administration of corticosteroids. The causes of adrenal insufficiency are summarized in Figure 2. 

Items 8-9 A 54-year-old man with miliary tuberculosis has developed signs of severe acute adrenal insufficiency. 

Glucocorticoids Regulate carbohydrate, lipid and protein metabolism block inflammation regulate body s immune response Indications Asthma, advance pulmonary tuberculosis, pericarditis, acute and chronic inflammation, adrenal insufficiency, antenatal use in preterm labor, hypercalcemia, cerebral edema, acute SCI, MS, shock Common drug examples ... 

The adrenal insufficiency that develops in Addison s disease results from the extensive yet not total destruction of the cortex of both adrenal glands. Various pathological conditions that may be responsible for this destruction include bilateral tuberculosis (68%), destructive atrophy (19%), amyloid degeneration (2%), and neoplasm (1%). In the remaining 10% of cases, Addison s disease results from a number of miscellaneous degenerative processes (venous thrombosis, arterial emboli, syphilis, and pressure atrophy). The physician should beware of the sudden withdrawal... 

Adrenal tuberculosis is usually of the fibrocaseous type and affects both cortex and medulla. Although it is not known whether the adrenal infection is primary, adrenal tuberculosis is often associated with tuberculosis of the urogenital tract. The tuberculosis usually starts in one gland and progressively invades the contralateral gland. Adrenal insufficiency develops only when 90% of the cortex of both adrenal glands is destroyed. 

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