{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:43Z","timestamp":1784557063571,"version":"3.55.0"},"reference-count":12,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T00:00:00Z","timestamp":1530835200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,7,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Primary adrenal insufficiency secondary to syphilis is extremely rare, with only five cases being reported in the literature. We report a case of adrenal insufficiency as a manifestation of\n                    <jats:italic>Treponema pallidum<\/jats:italic>\n                    infection (tertiary syphilis). A 69-year-old, previously fit and well Caucasian male was found to have adrenal insufficiency after being admitted with weight loss, anorexia and postural dizziness resulting in a fall. Biochemical testing showed hyponatraemia, hyperkalaemia, and an inadequate response to Synacthen testing, with a peak cortisol level of 302\u2009nmol\/L after administration of 250\u2009\u00b5g Synacthen. Abdominal imaging revealed bilateral adrenal hyperplasia with inguinal and retroperitoneal lymphadenopathy. He was started on hydrocortisone replacement; however, it was not until he re-attended ophthalmology with a red eye and visual loss 1 month later, that further work-up revealed the diagnosis of tertiary syphilis. Following a course of penicillin, repeat imaging 5 months later showed resolution of the abnormal radiological appearances. However, adrenal function has not recovered and 3 years following initial presentation, the patient remains on both glucocorticoid and mineralocorticoid replacement. In conclusion, this case highlights the importance of considering syphilis as a potential differential diagnosis in patients presenting with adrenal insufficiency and bilateral adrenal masses, given the recent re-emergence of this condition. The relative ease of treating infectious causes of adrenal lesions makes accurate and timely diagnosis crucial.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Infectious causes, including syphilis, should be excluded before considering adrenalectomy or biopsy for any patient presenting with an adrenal mass.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>It is important to perform a full infection screen including tests for human immunodeficiency virus, other blood-borne viruses and concurrent sexually transmitted diseases in patients presenting with bilateral adrenal hyperplasia with primary adrenal insufficiency.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Awareness of syphilis as a potential differential diagnosis is important, as it not only has a wide range of clinical presentations, but its prevalence has been increasing in recent times.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0030","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T03:12:58Z","timestamp":1530846778000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["An unusual cause of adrenal insufficiency and bilateral adrenal masses"],"prefix":"10.1530","volume":"2018","author":[{"given":"Su Ann","family":"Tee","sequence":"first","affiliation":[{"name":"1Department of Endocrinology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earn Hui","family":"Gan","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"},{"name":"2Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Zaher","family":"Kanaan","sequence":"additional","affiliation":[{"name":"3Departments of Ophthalmology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Ashley","family":"Price","sequence":"additional","affiliation":[{"name":"4Departments of Infectious Disease and Tropical Medicine, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Hoare","sequence":"additional","affiliation":[{"name":"5Radiology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon H S","family":"Pearce","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"},{"name":"2Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref131","doi-asserted-by":"crossref","first-page":"363","DOI":"10.15698\/mic2016.09.523","article-title":"Syphilis: re-emergence of an old foe","volume":"3","year":"2016","journal-title":"Microbial Cell"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"363","DOI":"10.15698\/mic2016.09.523","article-title":"Syphilis: re-emergence of an old foe","volume":"3","year":"2016","journal-title":"Microbial Cell"},{"key":"ref111","first-page":"337","article-title":"Addison\u2019s disease not caused by tuberculosis of the adrenal glands: one case caused by syphilitic gummae, another by metastases from bronchial carcinoma and two others from atrophy","volume":"7","year":"1954","journal-title":"Gazeta Medica Portuguesa"},{"key":"ref21","first-page":"479","article-title":"Rare case of Simmonds\u2019 disease possibly caused by syphilitic lesion. Clinical diagnosis: adrenal cortical insufficiency and autopsy study: severe atrophy of pituitary gland","volume":"14","year":"1966","journal-title":"Horumon To Rinsho"},{"key":"ref91","doi-asserted-by":"publisher","first-page":"201237","DOI":"10.1097\/RLU.0b013e318262adf1","article-title":"Gummatous syphilis of the adrenal gland https org","author":"van UffordHME","journal-title":"Clinical Nuclear Medicine"},{"key":"ref31","first-page":"337","article-title":"Addison\u2019s disease not caused by tuberculosis of the adrenal glands: one case caused by syphilitic gummae, another by metastases from bronchial carcinoma and two others from atrophy","volume":"7","year":"1954","journal-title":"Gazeta Medica Portuguesa"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1177\/003591573402700424","article-title":"Addison\u2019s disease associated with syphilis and fracture of the first lumber vertebra","volume":"27","year":"1934","journal-title":"Proceedings of the Royal Society of Medicine"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1177\/003591573402700424","article-title":"Addison\u2019s disease associated with syphilis and fracture of the first lumber vertebra","volume":"27","year":"1934","journal-title":"Proceedings of the Royal Society of Medicine"},{"key":"ref101","first-page":"479","article-title":"Rare case of Simmonds\u2019 disease possibly caused by syphilitic lesion. Clinical diagnosis: adrenal cortical insufficiency and autopsy study: severe atrophy of pituitary gland","volume":"14","year":"1966","journal-title":"Horumon To Rinsho"},{"key":"ref01","first-page":"19","article-title":"GnanasegaramMCouttsI case of adrenal insuf\ufb01ciency secondary to syphilis and dif\ufb01culties in the diagnostic work - up of https org","journal-title":"Australasian Journal Dermatology"},{"key":"ref81","first-page":"19","article-title":"GnanasegaramMCouttsI case of adrenal insuf\ufb01ciency secondary to syphilis and dif\ufb01culties in the diagnostic work - up of https org","journal-title":"Australasian Journal Dermatology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"201237","DOI":"10.1097\/RLU.0b013e318262adf1","article-title":"Gummatous syphilis of the adrenal gland https org","author":"van UffordHME","journal-title":"Clinical Nuclear Medicine"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2018\/1\/EDM18-0030.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2018\/1\/EDM18-0030.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:46:51Z","timestamp":1784555211000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,6]]},"references-count":12,"URL":"https:\/\/doi.org\/10.1530\/edm-18-0030","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,6]]}}}