An unusual cause of adrenal insufficiency and bilateral adrenal masses
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 Treponema pallidum infection (tertiary syphilis). A 69-year-old, previously fit and well Caucasian male was fo...
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Bioscientifica
2018-07-01
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Series: | Endocrinology, Diabetes & Metabolism Case Reports |
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doaj-e42d1bc1ffda4418bdffa8138ca1a86b2020-11-24T23:52:09ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732018-07-01111510.1530/EDM-18-0030An unusual cause of adrenal insufficiency and bilateral adrenal massesSu Ann Tee0Earn Hui Gan1Mohamad Zaher Kanaan2David Ashley Price3Tim Hoare4Simon H S Pearce5Department of Endocrinology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UKDepartment of Endocrinology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UKDepartment of Ophthalmology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UKDepartment of Infectious Disease and Tropical Medicine, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UKDepartment of Radiology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UKDepartment of Endocrinology, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UKPrimary 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 Treponema pallidum 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 nmol/L after administration of 250 μg 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.https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-18-0030 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Su Ann Tee Earn Hui Gan Mohamad Zaher Kanaan David Ashley Price Tim Hoare Simon H S Pearce |
spellingShingle |
Su Ann Tee Earn Hui Gan Mohamad Zaher Kanaan David Ashley Price Tim Hoare Simon H S Pearce An unusual cause of adrenal insufficiency and bilateral adrenal masses Endocrinology, Diabetes & Metabolism Case Reports |
author_facet |
Su Ann Tee Earn Hui Gan Mohamad Zaher Kanaan David Ashley Price Tim Hoare Simon H S Pearce |
author_sort |
Su Ann Tee |
title |
An unusual cause of adrenal insufficiency and bilateral adrenal masses |
title_short |
An unusual cause of adrenal insufficiency and bilateral adrenal masses |
title_full |
An unusual cause of adrenal insufficiency and bilateral adrenal masses |
title_fullStr |
An unusual cause of adrenal insufficiency and bilateral adrenal masses |
title_full_unstemmed |
An unusual cause of adrenal insufficiency and bilateral adrenal masses |
title_sort |
unusual cause of adrenal insufficiency and bilateral adrenal masses |
publisher |
Bioscientifica |
series |
Endocrinology, Diabetes & Metabolism Case Reports |
issn |
2052-0573 2052-0573 |
publishDate |
2018-07-01 |
description |
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 Treponema pallidum 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 nmol/L after administration of 250 μg 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. |
url |
https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-18-0030 |
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