{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T07:47:12Z","timestamp":1770968832674,"version":"3.50.1"},"reference-count":30,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,4,19]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>Primary adrenal insufficiency (PAI) is a potentially fatal disease. Adrenal tuberculosis(TB) causing PAI is rare in the developed world. We present a seemingly well, 78-year-old Caucasianwoman in the UK who developed adrenal crisis following elective hip surgery. Biochemical tests confirmed PAI and steroid replacement was initiated. Imaging of the abdomen demonstrated bilateral adrenal masses and a fluorodeoxyglucose positron emission tomography (FDG-PET) scan showed increased uptake in both adrenals suggestive of malignancy. Following a retroperitoneoscopic left adrenalectomy, histology showed caseating necrosis with xanthogranulomatous inflammation favouring a diagnosis of TB. She was commenced on anti-TB treatment. Diagnosing adrenal TB in the west can be challenging especially in the absence of extra-adrenal TB. FDG-PET scans can be falsely positive in presence of chronic active inflammatory conditions, such as TB, and a tissue diagnosis is required. It is important that clinicians remain vigilant of this important disease, which can masquerade as malignancy.<\/jats:p>","DOI":"10.1136\/bcr-2018-228532","type":"journal-article","created":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T06:50:18Z","timestamp":1559112618000},"page":"e228532","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Tuberculosis as a differential for bilateral adrenal masses in the UK"],"prefix":"10.1136","volume":"12","author":[{"given":"Maulee","family":"Arambewela","sequence":"first","affiliation":[{"name":"Endocrinology Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"},{"name":"Department of Physiology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Ross","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"},{"name":"Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Pirzada","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5953-2843","authenticated-orcid":false,"given":"Sabapathy P","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Sheffield, Sheffield, UK"},{"name":"Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,5,28]]},"reference":[{"key":"2025082702050462000_12.5.e228532.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66700-1"},{"key":"2025082702050462000_12.5.e228532.2","unstructured":"European Centre for Disease Prevention and Control\/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2018 \u2013 2016 data."},{"key":"2025082702050462000_12.5.e228532.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1994.tb02790.x"},{"key":"2025082702050462000_12.5.e228532.4","doi-asserted-by":"publisher","DOI":"10.1006\/jaut.1995.0009"},{"key":"2025082702050462000_12.5.e228532.5","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.67.793.984"},{"key":"2025082702050462000_12.5.e228532.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199610173351607"},{"key":"2025082702050462000_12.5.e228532.7","unstructured":"Addison T . On the constitutional and local effects of disease of the supra-renal capsules (special ed 9th): Samuel Highley, London, 1855."},{"key":"2025082702050462000_12.5.e228532.8","doi-asserted-by":"publisher","DOI":"10.1210\/er.23.3.327"},{"key":"2025082702050462000_12.5.e228532.9","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/309570"},{"key":"2025082702050462000_12.5.e228532.10","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.12809\/hkjr1615361","article-title":"Primary Adrenal Tuberculosis Causing adrenal Insufficiency","volume":"19","author":"Maller","year":"2016","journal-title":"Hong Kong J Radiol"},{"key":"2025082702050462000_12.5.e228532.11","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181db6b7a"},{"key":"2025082702050462000_12.5.e228532.12","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.33.602"},{"key":"2025082702050462000_12.5.e228532.13","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s00261-007-9352-8","article-title":"Addison\u2019s disease due to adrenal tuberculosis: MRI features","volume":"33","author":"Zhang","year":"2008","journal-title":"Abdom Imaging"},{"key":"2025082702050462000_12.5.e228532.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2006.11.025"},{"key":"2025082702050462000_12.5.e228532.15","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s00261-007-9352-8","article-title":"Addison\u2019s disease due to adrenal tuberculosis: MRI features","volume":"33","author":"Zhang","year":"2008","journal-title":"Abdom Imaging"},{"key":"2025082702050462000_12.5.e228532.16","doi-asserted-by":"publisher","DOI":"10.1007\/s005350050085"},{"key":"2025082702050462000_12.5.e228532.17","doi-asserted-by":"crossref","first-page":"336","DOI":"10.4329\/wjr.v7.i10.336","article-title":"Evaluation of primary adrenal insufficiency secondary to tuberculous adrenalitis with computed tomography and magnetic resonance imaging: Current status","volume":"7","author":"Huang","year":"2015","journal-title":"World J Radiol"},{"key":"2025082702050462000_12.5.e228532.18","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.3.773"},{"key":"2025082702050462000_12.5.e228532.19","first-page":"1301","article-title":"High accumulation of fluorine-18-fluorodeoxyglucose in turpentine-induced inflammatory tissue","volume":"36","author":"Yamada","year":"1995","journal-title":"J Nucl Med"},{"key":"2025082702050462000_12.5.e228532.20","doi-asserted-by":"publisher","DOI":"10.1007\/BF03165391"},{"key":"2025082702050462000_12.5.e228532.21","doi-asserted-by":"publisher","DOI":"10.4103\/0971-3026.40299"},{"key":"2025082702050462000_12.5.e228532.22","doi-asserted-by":"publisher","DOI":"10.1007\/BF03006610"},{"key":"2025082702050462000_12.5.e228532.23","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-005-0088-y"},{"key":"2025082702050462000_12.5.e228532.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1994.tb03784.x"},{"key":"2025082702050462000_12.5.e228532.25","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2009.59"},{"key":"2025082702050462000_12.5.e228532.26","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20498"},{"key":"2025082702050462000_12.5.e228532.27","first-page":"EE01","article-title":"Laboratory diagnosis of extra-pulmonary tuberculosis (EPTB) in resource constrained setting: state of the art, challenges and the need","volume":"9","author":"Purohit","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"2025082702050462000_12.5.e228532.28","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.020461-0"},{"key":"2025082702050462000_12.5.e228532.29","doi-asserted-by":"crossref","unstructured":"Ferreira S , Freitas-Silva M . The importance of computed tomography findings in detection tuberculous Addison\u2019s disease. EJCRIM 2017;4.","DOI":"10.12890\/2017_000622"},{"key":"2025082702050462000_12.5.e228532.30","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.12809\/hkjr1615361","article-title":"Primary adrenal tuberculosis causing adrenal insufficiency","volume":"19","author":"Maller","year":"2016","journal-title":"Hong Kong J Radiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228532","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:05:13Z","timestamp":1756285513000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5,28]]},"published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1136\/bcr-2018-228532"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228532","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]}}}