ADRENAL TUBERCULOSIS - A REVIEW OF 35 CAS ES OF PRIMARY ADRENAL INSUFFICIENCY SEEN IN CENTRAL TUNISIA

Although tuberculosis is prevalent in Tunisia, data on adrenal tubercu losis are scant. Thirty-five consecutive patients with adrenal gland h ypofunction diagnosed on the basis of hormone assays between 1977 and 1990 were studied. There were 18 males and 17 females and age ranged f rom 22 to 72 years. All patients underwent investigations to look for tuberculosis in another site, a tuberculin skin test, tests for the tu bercle bacillus in sputum samples, and plain films of the chest and ab domen; the adrenal glands were evaluated by ultrasonography in ten pat ients and computed tomography in two. Tuberculosis was considered the cause of adrenal insufficiency in 16 (45.7%) patients (9 male and 7 fe male). However, this diagnosis was firmly established in only 11 (68%) of the 16 patients, based on the presence of tuberculosis in another site (n = 10) and/or calcifications in the adrenal glands (n = 3). In five cases, tuberculosis was considered likely based on a positive tub erculin skin test. The incidence of adrenal tuberculosis showed no cha nge over time. The limitations of classical diagnostic criteria are un derscored and suggest that computed tomography should be performed in all patients with peripheral adrenal insufficiency.